There are disparities in the use of antibiotics in the world, with some countries overusing antibiotics, while others lack sufficient access to the medicines, a new report by the World Health Organisation has shown.
The report, which collected data on antibiotic consumption for human healthcare from 65 countries, shows there are wide differences in consumption of antibiotics in different countries.Using a measurement called a defined daily dose (DDD), the average dose a patient needs everyday, to compare drug consumption in different countries, the report showed that the country with the lowest rate of antibiotic use is Burundi which has a rate of four defined daily doses (DDD) per 1,000 inhabitants per day.
In Southern Africa, South Africa had the highest antibiotic consumption rates of 33 and 27 daily defined doses per 1,000 people. Globally, the country with the highest rate of antibiotic consumption was found to be Mongolia, with a rate of 64 DDD.
“Overuse and misuse of antibiotics are the leading causes of antimicrobial resistance. Without effective antibiotics and other antimicrobials, we will lose our ability to treat common infections like pneumonia,” said Dr Suzanne Hill, director of the Department of Essential Medicines and Health Products at the WHO.
Antibiotics are often wrongly prescribed for viral infections like colds and flu where they have no benefit, and half of all doses are given to livestock for growth.Deemed a medical marvel for transforming modern medicine by treating and preventing bacterial infections, antibiotic are losing their magic and becoming ineffective against infections, because the drugs are routinely prescribed for infections they do not treat, or for which they are not needed.
“More than 70 per cent of antibiotics prescribed are either given unnecessarily or used improperly,” says Infectious Diseases Specialist Dr MosepeleMosepele. He said that when antibiotics are used too much, they would not work anymore; instead they kill.
Dr Mosepele said there was need to take urgent action, such as enforcing prescription-only policies, to reduce unnecessary use of antibiotics. Last year, the World Health Organisation published a list of 12 bacteria, which pose the greatest threat to human health because they are resistant to antibiotics.The list was drawn up in a bid to guide and promote research and development of new antibiotics to address growing global resistance to antimicrobial medicines.
Drug-resistant infections are already responsible for an estimated 700,000 deaths every year. If no action is taken, they are expected to kill 10 million people annually by 2050. The WHO report found that amoxicillin and amoxicillin/clavulanic acid – first or second-line treatments for common infections – are the most frequently used antibiotics worldwide. But the report also found that some third-line treatments, which it urges should be used with caution, are being consumed at high levels.
“Reserve” antibiotics, which should only be used as a last resort for treatment of specific infections caused by multi-drug resistant bacteria, account for less than two per cent of total antibiotic consumption in most high-income countries and were not reported by most low- and middle-income countries.
BoMRA warns of cancer-causing impurity
Botswana Medicines Regulatory Authority (BoMRA) is investigating if ranitidine, a common heartburn medicine, has a chemical contamination, which could cause cancer.
The drug is also known as Zantac, Uptake, Austin and R-Lok.
BoMRA issued a warning recently following an announcement on September 13, by the US Food and Drug Administration (FDA) that it had learned that some ranitidine medications, including those known by the brand name Zantac, contain low levels of N-nitrosodimethylamine (NDMA), an impurity that could cause cancer.
NDMA is a possible cancer-causing chemical linked to liver damage. Since last year, the FDA has been investigating NDMA and other impurities in blood pressure and heart failure medicines known as angiotensin receptor blockers or ARBs. However, the FDA cautioned that levels of the NDMA appeared low and not much higher than when the chemical is present in foods like processed or grilled meat. The FDA said: “Although NDMA may cause harm in large amounts, the levels the FDA is finding in ranitidine from preliminary tests barely exceed amounts you might expect to find in common foods”.
Over-the-counter ranitidine is approved to prevent and relieve heartburn and can be prescribed to prevent ulcers of the stomach and intestines. In a statement, BoMRA told people they could still keep taking the medicine or ask doctors to prescribe one of many drugs that treat heartburn or ulcers. The health product watchdog cautioned patients who had been prescribed Ranitidine from stopping without an alternative, advising patients instead to talk to their health professionals before they stop or switch to other medicines.
“BoMRA is urgently liaising with the registered suppliers of ranitidine-containing medicines to investigate the presence of NDMA in Botswana ranitidine products; and will update the public on the outcome of these investigations,” reads the statement.
BoMRA Spokesperson, Israel Kgosidiile said there is no evidence at this stage that the impurity has caused any harm to patients.
“There is no recommendation for patients who have ranitidine to stop taking it. If a patient has any questions they should speak to their doctor or pharmacist,“ he stated.
‘Cancer took away my boobs, not my life’
Sun Health: What events led up to your diagnosis, or, how did you discover that you were suffering from cancer?
Mpho Kgaodi:My journey with Breast cancer started in 2012. Around April I felt a lump on my right breast. It was not painful at all, just slightly itchy. It was on the upper part of my breast. I ignored it for about three days but it kept nagging me and then I decided to go see my doctor. He also confirmed that there was a lump on my breast He sent me for mammogram that confirmed an abnormality on the structure of my right breast. I then went to see him with the results and he informed me that there are two ways to test that lump – Biopsy, which meant that he will be taking a piece of that lump to send it to the laboratory for examination and the other option was to totally remove the lump, Lumpectomy. I decided that he removes the whole lump, because I really didn’t want that Lump on my breast.
SH: We know that about 10% of all breast cancers are hereditary. Are there other women affected in your family?
MK: I don’t know of any other woman or even man in my family who has had cancer, though it is hereditary.
SH: What were your first thoughts when you received the diagnosis?
MK: I cried for a brief moment. I was overwhelmed with emotions, fear of death. I quickly recovered from that dreadful thought and remembered that I have a great husband and three boys. I felt that I had so much to live for.The doctor informed me about the options I had regarding treatment and he gave me time to think about it. I drove back home to Lobatse and by the time I arrived at my house, I had already made up my mind that I am going for total removal of the breast. I broke the news to my family and they were just as shocked as I was when the doctor broke the news to me. I explained to them my decision to go for surgery and they were very supportive. Few weeks later, I went for a mystectomy.
SH: How long were you in treatment
MK: The surgery was followed by Chemotherapy. The first time I walked into the oncology centre, I found so many people there already. I then realised that I am not the only person with cancer, it is so many of us. It gave me strength and courage. I had heard that the side effects of chemo are brutal, seeing those people made me realise that if others can do it so can I. I decided to go for it as I had so much will and spirit to stay alive and raise my kids. After the second session of chemo, I started losing my hair, nail beds turned black. I was never discouraged though, despite my aching body and the constant nausea after chemo. I had six cycles of it. In 2013 around April again, I experienced severe pain on my left breast, but with no Lump. My doctor again recommended I go for a mammogram. It confirmed cancer which was still at stage 1. I then insisted that they remove the breast. I would lose both my breasts but I knew staying alive for my boys was more important. Other people thought the pain was psychological, and I knew what I felt and my mind was made up. I had the second mastectomy and had to go through another cycle of chemo which I completed. I am now on oral medication. I take my tablet daily. It is recommended that I take it for ten years. I have just started on my year 6 on the tablet. I do go for regular check ups, to establish if the cancer is not back.
SH: What helped keep your spirits up and gave you support during this period?
MK: A good friend of mine and colleague told me about Journey of Hope Botswana. He introduced me to them, and I had tremendous support from them. I also went to Cancer Association Botswana to introduce myself. My family has also been my backbone, supporting me through it all. I am so greatful. On days that my spirits are low, I always take my mind to positive thoughts. I try to remind myself of the good times, sometimes I even find myself laughing out loud.
SH: How has this affected you at a psychological level?
MK: My life has not really changed for the worst. Like the saying “when life gives you lemons, make lemon aid out of them”. I lost my job after the second diagnosis of cancer. While this affected my family financially I never got discouraged, as this gave me time to take care of my family. I am a full time stay home mom. I walk this journey with my family. My boys understand that I had Cancer but now I am okay. They sometimes check if I have taken my medication, and they would even ask about my next appointment. I am blessed to have them.
SH: Facing the diagnosis of breast cancer is one of the most feared experiences in our society. What has been your experience as you worked with communities through Cancer Association of Botswana (CAB)?
MK: Working with CAB has been eye opening. Through motivational talks and other actives like the annual stiletto walk, the message has been positively received. There is still a lot to be done though, especially to make people understand that breast cancer is NOT a death sentence. So many lives can be saved.
SH: Amongst raising awareness, cancer awareness month is about celebrating individuals like yourself and their triumphs over cancer. Is there anything you would like to say to the community of cancer survivors and women in general?
MK: I have learnt so much from being diagnosed with cancer. I appreciate life more. I never used go and see a doctor without any pains or any thing “wrong” with my body. Now I do it regularly and so far I always get a clean bill of health. I encourage everybody to do regular self -breast examination. It is easy, convenient, cost-effective and can really help with early detection. I believe there is a lot to be done as far as breast cancer awareness. Remember men can also have breast cancer.
To all those who are going through cancer at the moment, remember you are not alone. Let’s walk this journey together. Let’s walk with Hope, Courage and Strength. There is life after cancer. Cancer took away my boobs it did not take my life. As October is breast cancer awareness, let’s support those affected, honour the survivors and remember the fallen.
PINK RIBBON ALWAYS