Last week, medical practitioners from Africa were urged during a meeting in Kigali to increase collaborative diagnostics with laboratory experts or pathologists in the treatment chain in a bid to boost chances of accurate diagnosis, which will ensure reduction in mortality rates on the continent.

Among the major areas of concern, experts noted that apart from just lack of emphasis on specific diagnosis, pathology in sub-Saharan faces challenges related to inadequate healthcare infrastructure, laboratory capability and diagnostic accuracy.

During the meet, Prof Gunturu Revathi, an associate professor and consultant microbiologist at the Aga Khan University Hospital Nairobi, urged policy makers as well as the entire chain of physicians to emphasise the importance of laboratory testing, strengthening the existing healthcare infrastructure and monitor test quality, among others.

Speaking of the importance of laboratory testing and monitoring test quality, Dr Bosco Ndihokubwayo, the managing director at the World Health Organisation (WHO) Regional Office for Africa Brazzaville-Congo, said one of the biggest problems facing the health sector as a result of misdiagnosis is antibiotic resistance.

Ndihokubwayo noted that the magnititute of this problem is not very well known locally, but says only few countries do surveillance on antibiotic resistance, which is still a challenge in terms of doing away with certain conditions.

What is antibiotic resistance?

According to Ndihokubwayo, antibiotic resistance is when the bacteria continues to multiply during the process of treatment, and it occurs when an antibiotic has lost its ability to effectively control or kill the bacteria.

He says that some infections can even become life-threatening in case of antibiotic resistance.

"If one has an antibiotic-resistant bacterial infection, chances of having bigger complications are high. Also, one may remain infectious for a long time and it’s even worse if they pass the infection to other people. This calls for more attention on surveillance to eradicate the problem,” says Ndihokubwayo, emphasing that accurate laboratory tests are the precursor to determing the right antibiotic to treat a particular pathogen.

Jean Marie Habimana, a medic at University Teaching Hospital Kigali (CHUK), explains that frequent prescription of a broad-spectrum of antibiotics in place of specific antibiotics can also cause antibiotic resistance.

He further notes patients not adhering to the duration of the dosage during treatment as directed by their doctors is another major contributor to antibiotic resistance, since some of the bacteria may survive and later become resistant.

US-based Mayo Clinic says antibiotic resistance can also arise in animals.

"Misusing and overusing antibiotics can lead to the development and spread of antibiotic-resistant bacteria, which in turn may lead to antibiotic-resistant infections.

"Antibiotic-resistant bacteria can then spread to other animals that are raised in the same environment, animal products that we eat, such as chicken and steak, produce, through contaminated water or soil, the environment, through animal feces, prepared food, through contaminated surfaces, such as chopping vegetables on an unwashed cutting board that was used to cut raw chicken,” they explain.

Medics also warn that overuse of antibiotics – especially taking antibiotics even when they’re not the appropriate treatment – promotes antibiotic resistance. Antibiotics treat bacterial infections but not viral infections. For example, an antibiotic is an appropriate treatment for strep throat, which is caused by the bacterium Streptococcus pyogenes. It’s not, however, the right treatment for most sore throats, which are caused by viruses.

If you take an antibiotic when you actually have a viral infection, the antibiotic is still attacking bacteria in your body – bacteria that are either beneficial or at least not causing disease. This misdirected treatment can then promote antibiotic-resistant properties in harmless bacteria that can be shared with other bacteria.

Rachna Pande, a specialist in internal medicine, says some of the germs which are resistant to existing antibiotics like fluoroquinolones, sulphur drugs and cephalosporins include Escheria coli, kleibsella, clostridium difficile, pseudomonas, salmonella typhi and actinobacter.

She explains this is the reason chloroquin is no longer effective in malaria treatment.

"Due to antibiotic resistance, hospital-acquired infections have also become challenging to treat and have become a cause for more sickness and deaths,” Pande says.

How to prevent it

"Infections caused by viruses such as colds and flu, for some people don’t require to be treated by antibiotics; rather antiviral medications are ideal. People should avoid self-medication and should only get medication when only prescribed by the right physician,” says Ndihokubwayo.

On the other hand, following instructions to take the medicines strictly as directed by your doctor is also important in preventing antibiotic resistance.

Pande says prevention of antibiotic resistance lies in discrete use of antibiotics, adding that this medication should be used for conditions like common cold, mild fever and cough.

"Doctors have to be discrete in prescribing antibiotics basing on strong evidence that the infection exists clinically or with laboratory results. Due precautions are needed to prevent cross infection in healthcare settings. It is also important to adopt measures to strengthen immune system by having a balanced diet with adequate proteins, avoiding junk food, doing regular exercise and staying stress free,” she says.

According to experts, antibiotic resistance can also result from consuming meat products from animals that were recently treated with certain drugs. They also advise that consumption of processed foods should also be regulated because some chemicals used to preserve them may also lead to antibiotic resistance.

Consequences of antibiotic resistance

The major consequence of wrong medication is that pathogens become sensitive to antibiotics, and Habimana says, as such, common bacterial infections are becoming more ineffective during treatment.

"The affected patients cannot be treated effectively by any other available antibiotics, which may lead to complications and sometimes death. Additionally, such patients may need more care, as well as the use of alternative and usually more expensive antibiotics, which again could lead to severe side effects,” he says.

Habimana notes that urinary tract infection, pneumonia, skin infection, diarrhea and bloodstream infections are among the common infections that are prone to antibiotics resistance.

However, a recent WHO report indicates that resistance of common bacteria to antibiotics has reached alarming levels in many parts of the world, and that there is an increase of resistance to major antibiotics of common bacteria such as, escherichia coli, urinary tract infections and staphylococcus aureus.

The report goes further to point out that progress in modern medicine, which relies on the availability of effective antibacterial drugs, is now at risk, explaining that common infections, such as pneumonia, may not respond to available or recommended drugs like penicillin, which puts the lives of patients at risk.

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EXPERTS' VIEWS ON ANTIBIOTIC RESISTANCE IN CHILDREN

Gonzalue Niyigaba, medic at University Teaching Hospital Kigali (CHUK)Apart from just high costs due to prolonged treatment, there can be cases of emergencies where a child could need quick treatment to save their lives and this puts their lives in danger. It can also lead to re-current infections, especially if one is suffering from influenza.

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Theogene uwiringiyimana, medical studentNot following instructions prescribed by a pediatric, which is one of the causes of resistance, can put children at risk of developing renal problems, especially if they are suffering from urinary truck infections. Besides, going for tests whenever the child is sick is essential as it helps reduce the risks of wrong medication.

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Solange Mutangana, nurseChildren are more prone to infections which requires antibiotic use and their treatment options are limited. For this reason, it may cause a child prolonged medication, which puts their life at risk in general. Children should be taken through proper examination before being given certain medications.

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Francis Kazungu, general practitionerAlthough antibiotic resistance poses risks to everyone, children are more at risk. Because of administering different antibiotics, children are more at risk of contracting E.coli.This happens after four to six months after treatment with consistent antibiotic resistance.

Compiled by Lydia Atieno

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WHY SELF-MEDICATION IS HARMFUL

Taking a dose of your own medicine is not always a good idea. It can leave you with a bad stomach at the best and in an emergency ward at the worst. Many of you may not be aware, but these well-meaning drugs are not without side-effects and can play havoc with your system if taken without professional advice. We have for you the most commonly abused over-the-counter medicines and their potential side-effects.

Pain killers

What they arePain killers are drugs used to relieve pain. Most of them belong to a class of drugs called Non-steroidal anti-inflammatory drugs [NSAIDS], which control inflammation, fever and mild pain. Taking them without consultation, buying them over and over again using the same prescription, taking a double dose for quicker relief or using the left-over medicines later for similar symptoms can put people in trouble.

Potential side-effects