[Ngo-sanrm] Antibiotic abuse killing thousands in Thailand

Mon Nov 14 09:05:35 ICT 2016

This is about Thailand -- but the problem likely extends to Viet Nam as
well.  Though the focus of this article is on human health, the information
about overuse of antiobiotics for animals raised as food -- beef cows,
pigs, chickens, even farm raised catfish -- should be of concern to the
agriculture sector as well as the public health sector.  CS

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The Straits Times
<http://www.straitstimes.com/asia/se-asia/antibiotic-abuse-killing-thousands-in-thailand>
14-Nov-2016

Antibiotic abuse killing thousands in Thailand
<http://www.intellasia.net/antibiotic-abuse-killing-thousands-in-thailand-554158>

In a softly-lit suite of Bangkok’s Praram 9 Hospital, Songchai (not his
real name) slowly scrawls out his thoughts on paper. Five months in coma
have left him with throat muscles so weak he needs a breathing tube, which
reduces his words to hollow rasps. Just months ago, his heart was straining
to pump blood through a body under attack by a strain of severe and
drug-resistant bacteria.

“The doctor told my wife to be prepared for my death,” says Songchai, who
spoke to The Straits Times on condition of anonymity.

To save his life, doctors gave him the strongest antibiotic available. It
helped him pull through, but also destroyed his kidneys. The 66-year-old
retired marketing director now has to undergo thrice-weekly dialysis for
the rest of his life.

Songchai is lucky. An average of two people die every hour from
multidrug-resistant bacterial infections in Thailand, according to a
landmark study funded by the kingdom’s health ministry and Britain’s
Wellcome Trust, and published in September.

The study used micromicrobiology databases, hospital admission databases
and the national death registry to estimate that multidrug-resistant
bacterial infections killed 19,122 people in Thailand in 2010. Thailand’s
population is 68 million.

The death rate is high compared to the United States or Europe. In the US,
there were 23,000 deaths in a 316 million population in 2013; and 25,000
deaths a year in the European Union – from a 500 million population in
2007, according to the study’s senior author, Dr Direk Limmathurotsakul of
Mahidol University in Thailand.

The problem is not confined to these countries. Some call it the “silent
tsunami”: The improper use of antibiotics for humans and livestock around
the world is leading to the proliferation of increasingly drug-resistant
microorganisms, creating new strains of “superbugs” that can be defeated
only by “last resort” medicine with toxic side effects.

The World Health Organization (WHO) warns that “improvements in global
health over recent decades are under threat”. The microorganisms that cause
tuberculosis, malaria, urinary tract infections, pneumonia and food
poisoning, for example, are becoming increasingly resistant to a wide range
of medicines.

“Some cases of tuberculosis and gonorrhoea are now resistant even to
antibiotics of the last resort,” the WHO said last year.

The problem is particularly stark in Thailand. “(People) feel they can buy
stronger and stronger antibiotics,” said Dr Direk.

“They feel the problem is confined to them. They don’t understand
second-hand antibiotic resistance, that it can (affect) friends and family
and other people in the hospital.”

*AMOXICILLIN FOR SORE THROAT*

Many developing countries with poor healthcare systems allow antibiotics to
be sold without a prescription. In middle-income Thailand, which draws
medical tourists from all over the world, antibiotics are freely available
in pharmacies and even convenience stores.

The Thai capital is dotted with pharmacies dispensing drugs. Indeed, a
particularly popular hub can be found by Victory Monument, a bustling
traffic circle in central Bangkok.

There, anyone can easily buy drugs for high blood pressure, diabetes and a
whole range of other ailments, alongside guava or chicken rice touted by
hawkers crammed by the storefronts. Runners armed with wads of baht and
printed photographs of medicine they are tasked to buy jostle for attention
at the busiest stores alongside buyers from Myanmar, Cambodia and even
Singapore.

Standing on the other side of one of the counters is Ms Nattiya
Apisittinantakul, a 25-year-old pharmacist. At the request of The Straits
Times, she fishes out a selection of the antibiotics on sale, ranging from
generic blue-green capsules of amoxicillin to brand-name ones like Pfiser’s
Zithromax. Some Thais buy the medicine because the wait to see a doctor is
too long, she says. Others bring empty boxes of drugs previously prescribed
to them. Many are familiar with amoxicillin.

“If they had a sore throat yesterday, they would come in and say ‘I want
amoxi’,” says Ms Nattiya in exasperation. “Even if I explain that they
don’t need it, they wouldn’t believe it. Or they would say, ‘I want to buy
it to keep it in my house’.”

Many also ask for the smallest available packs of amoxicillin – a 30-baht
(S$ 1.20) strip of 10 generic capsules – and need to be persuaded to buy
another strip to make it a full course of antibiotics. Taking an inadequate
amount of antibiotics can create drug-resistant bacteria.

Some directly request Norfloxacin, which can be used to treat travellers’
diarrhoea. “They don’t even say they have diarrhoea anymore,” Ms Nattiya
laments. “They ask, do you have ‘norflox’?”

*IT’S IN YOUR MEAT TOO*

Antibiotics used on livestock is another concern. Drug-resistant bacteria
spreads through direct contact between humans and farm animals, ingested
meat or the environment.

In many large industrial farms, where cramped conditions allow diseases to
spread fast, antibiotics are often used on healthy animals to prevent
rather than treat illnesses.

Farmed seafood from the region in particular has been getting red-flagged.
Vietnam’s Department of Animal Health, for example, found this year that
most of the 139 catfish farms it surveyed in the Mekong delta region were
using antibiotics. According to a report in Tuoi Tre News portal, one of
the antibiotics detected included colistin, which can damage kidneys.

Over the past two years, the US Food and Drug Administration has put
several peninsular Malaysian shrimp producers on its “import alert” list
for using nitrofurans, a banned antibiotic.

In June this year, one Thai firm, Narong Seafood, was placed on the same US
alert list after drug residue was found in its shrimp.

According to Thailand’s National Antimicrobial Resistance Surveillance
Centre website, the kingdom uses about 10 billion baht worth of antibiotics
every year. It is unclear how much is used on animals.

Thailand’s Food and Drug Administration as well as the Department of
Livestock Development did not respond to requests for interviews.

While farmers in Thailand are banned from using antibiotics as growth
promoters, experts say there are still information gaps on how and where
the drugs are used on farms. This is something the Food and Agriculture
Organisation (FAO) is working with the Thai government to fix, along with
raising awareness of the problem.

Dr Wantanee Kalpravidh, an FAO regional manager, thinks the stringent
standards set by countries importing Thailand’s farmed products motivate
companies to rein in antibiotic use. But cutting back on its use may not
save money, since farms need to vaccinate the animals and put up biosafety
barriers to protect the animals from disease.

She suggests governments consider dangling incentives before conscientious
farmers. “Can the government recognise this as corporate social
responsibility and reduce their tax?” she said.

After all, the benefits from reducing indiscriminate use of antibiotics
extend to the larger society, and go beyond borders.

It will help lower healthcare costs, for one thing. At Bangkok’s public
Ramathibodi Hospital, staff have to wear a 12-baht, one-time-use protection
gown every time they approach a patient infected with a superbug. Staff in
one intensive care ward with 20 of these patients go through 10,000 such
gowns a month, reveals the hospital’s deputy director Kumthorn Malathum.

In conjunction with World Antibiotics Awareness Week starting on November
14, the hospital will set up information booths to educate patients about
proper use of antibiotics. “People don’t often see the long-term effects
caused by superbugs,” says Dr Kumthorn. “People think patients just die
quickly and the (treatment) cost is low. But infection caused by superbugs
also affects your long-term quality of life.”

Songchai’s troubles began earlier this year, when he fell while going down
the stairs at home.

His knees hurt so much he resorted to taking an over-the-counter muscle
relaxant three times a day, on top of a cocktail of four to five drugs for
diabetes, high blood pressure and other ailments.

The combination of drugs proved too much for his kidneys, so he had to
undergo temporary dialysis. It was during the treatment that he was felled
by the drug-resistant superbug.

The avid golf and billiards player is now reduced to watching such
tournaments on television at home.

He scribbles glumly on a piece of paper: “Don’t use (antibiotics) by
yourself. Ask the doctor first.”

http://www.straitstimes.com/asia/se-asia/antibiotic-abuse-killing-thousands-in-thailand

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