June 24, 2011

THAILAND: Thai Campaign Tempers Use of Antibiotics

CHOKECHAIPATTANA, Thailand / Inter Press Service / June 24, 2011

By Marwaan Macan-Markar


Every month, Buddhist monk Phra Patarapong visits this village of mostly wooden houses on stilts and draws crowds, but not just for his regular sermons on spiritualism. People come to see him also for his tips on health, in particular his warnings about the excessive use of antibiotics.

"Drink warm lemongrass when you have a cold," the 35-year-old monk advised a group of some 40 men, women and children who had gathered in Chokechaipattana’s airy community centre on a recent afternoon. "Clean food, clean drinks and regular exercise are better for you to stay healthy.

"The body can recover from viral infections," he continued, as some nodded in agreement. "Antibiotics cause unnecessary expenses to households, have adverse reactions (to the body), and overuse causes antibiotic resistance."

Such tips by the saffron-robed visitor, who jokingly describes himself as a "public health monk," are not out of the ordinary in this community of corn and cattle farmers. In Saraburi province, more than 100 kms north of Bangkok where Chokechaipattana is located, public health experts have been waging a campaign to keep people healthy by weaning them away from the pervasive habit of turning to antibiotics for any ailment.

In 2007, public health experts in Saraburi launched a pilot project called Antibiotics Smart Use (ASU). It has since spread to three other provinces – Ayuthaya, Ubon Rachathani and Samut Songkhran – as part of the second phase.

"This effort is to encourage people to change their attitude and go for the rational use of antibiotics," says Nithima Sumpradit of the International Health Policy Programme at the Public Health Ministry. "Thais take antibiotics as if they were aspirin."

Her effort to spread the ASU’s message is to caution patients from turning to antibiotics when infected with upper respiratory infections (URI), acute diarrhoea and simple wounds. "The body (does not need antibiotics to) heal itself from the three diseases," she told IPS. "And if people want something to take home after visiting a clinic, we prescribe herbal medicines."

Thailand’s effort to stem the liberal use of antibiotics in the wake of a looming crisis – antibiotic drug resistance caused by the excessive use of antibiotics – mirrors a global worry. In April, the World Health Organisation (WHO) marked World Health Day highlighting the need for "rational use of antibiotics" as its global theme for 2011.

Antibiotics resistance has become a global problem, transcending national boundaries, the Geneva- based health body warned. "The microbes that cause many diseases are becoming resistant to the drugs that are the mainstay of treatment of communicable diseases," Samlee Plianbangchang, WHO’s South and East Asia regional director noted during the April event.

Antibiotics have long been described as the "wonder drug" of modern medicine since the first antibiotic, penicillin, was discovered in 1928. That breakthrough by Alexander Fleming helped reduce deaths caused by infections from micro-organisms such as bacteria and fungi.

But in Thailand, people are using the drug even for the simplest ailments. The demand for it is reflected in the over 20 billion baht (660 million U.S. dollars) of antibiotics Thailand imports and produces annually, reveals Niyada Kiatying-Aungsulee, director of the Social Research Institute at Bangkok’s Chulalongkorn University.

It explains why antibiotic drugs are the most popular treatment in this country of 66 million people – accounting for 20 percent of all drugs used. "It is amazing because we have more use of short-term drugs like antibiotics than long-term drugs for cardiovascular disease," confirms Sumpradit.

Such high use stems from the ease with which antibiotics are made available to patients: doctors prescribe them readily and they can be easily bought over the counter without a prescription at the ubiquitous pharmacies located on most streets in this country.

"Patients have got so used to it that they expect to get antibiotics every time they come to the pharmacy," remarks Kankanid Kidtipornpechdee, the head of the pharmacy at the state-run Donpud district hospital in Saraburi. "It is easy for them to buy it at the supermarket, the mini-mart or the private pharmacy if we refuse."

And her attempts to warn against the excessive use of antibiotics – refusing patients who want the drugs when they do not have a prescription – often results in confusion. "At first they don’t trust what we say because they have got so used to it. They believe antibiotics are a must to get better from a cold or fever," she explained to IPS.

The WHO is one of the international groups sounding the alarm against complacency towards spreading antibiotic resistance. "Superbugs" like New Delhi Metallo-Beta-Lactamase (NDM-1), an enzyme that makes bacteria resistant to a broad range of beta-lactam antibiotics, are among the signs of this worrying development.

The need to "safeguard antibiotics for future generations," as the WHO states, has been compounded by the absence of new antibiotics in the pipeline. Between 2000 and 2010, only three new antibiotics have been discovered, a contrast from the golden age of the "wonder drug" in the 1940s, 1950s and 1960s, when 26 new antibiotics were produced over three decades.

The reality that antibiotics have become a finite source and their overuse is reducing their potency is gradually being accepted by the over 100 families living in Chokechaipattana. "People are learning to adjust to not getting antibiotics when they go to the health clinic," says Nitchapa Netsringern, a health volunteer from the village. "But with new knowledge, there are always those who will believe and those who will not believe."

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