Misconceptions about antibiotics

A survey by NUS shows that 78 per cent of patients in Singapore who consulted doctors for upper respiratory tract infections (URTI) did not know that antibiotics are ineffective against viruses. Two-thirds thought that the drugs could more quickly cure their cough, sore throat and runny nose, symptoms usually caused by viruses. Furthermore, a third of the respondents expected to be given antibiotics for such ailments and half of these would ask for the medicine or go to another general practitioner (GP) if not prescribed.

The findings are of grave concern as antibiotic resistance represents one of the biggest global health threats today.

The study conducted by students from the NUS Yong Loo Lin School of Medicine in February 2015, under the supervision of public health experts from the NUS Saw Swee Hock School of Public Health, was part of their Year 4 Community Health Projects. The survey included 914 adult patients consulting doctors at NUS University Health Centre and 23 private sector primary care clinics. The study revealed that 12 per cent of respondents kept antibiotic stocks at home, 14 per cent took leftover antibiotics and 7 per cent shared their antibiotics with family members.

Lead investigator Dr Mark Chen, an assistant professor with the Saw Swee Hock School of Public Health, highlighted that using antibiotics unnecessarily contributes to the spread of drug-resistant bacteria in the community. He said, “Common bacteria are now harbouring resistance to multiple antibiotics, which limits the number of options, or give us no options, to treat these infections.”

First author Darius Pan, now a House Officer at a public sector hospital, revealed that patients who reported inappropriate practices like keeping leftover antibiotics were also more likely to expect their doctors to prescribe the drugs.

Wrong use of antibiotics can result in longer or less effective treatment, allergic reactions and serious side effects. Co-investigator Dr Lee Tau Hong, Associate Consultant at Tan Tock Seng Hospital’s Department of Infectious Diseases, noted that drug-adverse reactions from antibiotics have been reported to be a leading reason for emergency admission.

Dr Chen suggested deferred prescription as a possible solution — a patient is not given antibiotics on first consultation, but if the symptoms worsen on follow-up, the doctor reassessing the same patient decides if the infection warrants an antibiotic. Co-investigator Dr Lim Fong Seng from the NUS University Health System’s Division of Family Medicine, added that it is hence important to follow the recommendation by the Ministry of Health (MOH) and primary care professionals that patients not doctor-hop but return to the same GP for follow-up.

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From left: Dr Lee, House Officer Magdalene Lee, Darius, Dr Chen and Dr Lim were co-authors of the study

Published in BioMed Central Family Practice this month, the report has significant implications for public policy and health implementation, said Dr Chen. He believes that public education is key to dispel misconceptions and misuse of antibiotics. The researchers propose interventions in the form of clinic and community-based education to promote rational use of such medication, and health teaching in schools from young.

Estimates based on a 2010 survey by MOH suggest that more than 3 million people made URTI-related visits to private GP clinics. Even if a small proportion are getting antibiotics inappropriately, this adds up to a lot of antibiotics being used in the community and can contribute to a situation favouring resistant bacteria.