Study on mass distribution of antibiotics worrying: medics

Dar es Salaam. A new study involving nearly 200,000 children in Tanzania, Malawi and Niger has suggested that antibiotics should be widely distributed on a massive scale as a strategy to cut down on deaths of new-borns and infants.

However, medical experts in Tanzania and elsewhere around the world are opposed to the findings, saying that mass distribution of the medications could speed up the emergence of bacteria that are resistant to antibiotics, especially in poor countries.

The study, published in The New England Journal of Medicine, found that giving two doses a year of an antibiotic could sharply reduce infant mortality by as much as 25 per cent.

Researchers enrolled 190,238 healthy children for the study – and, over a period of two years, they gave half of them four doses of the antibiotic ‘azithromycin.’ The other half was given a placebo: a a substance that has no therapeutic effect – and which is usually used as a control in testing new drugs.

The children were aged under-5, and were from 1,500 villages of the three sub-Saharan countries: Malawi, Niger and Tanzania.

The study’s findings, however, have received a serious backlash from among clinicians practising at various health facilities in Tanzania.

Those who spoke to The Citizen said the new findings go against the current treatment guidelines which suggest that people should only take antibiotics after they have been diagnosed with a bacterial infection.

A specialist in new-born health from the Muhimbili University of Health and Allied Sciences (Muhas), Prof Karim Manji, warned of long-term consequences in case the results of the study are adopted in public health programs in Tanzania.

“It is not wise to even consider implementation of such outcomes,’’ he said – insisting that “[The study gives a]...wrong message: that prophylactic antibiotics and mass distribution are the ‘way forwar.’ This is not correct.”

Prof Manji – who is also a Fellow of the Royal College of Physicians in London – suggests that the recent trial must be re-evaluated before any country implements the findings.

However, a global science publication, ‘Nature,’ has quoted some officials who were enthusiastic about the new strategy which was funded by the Bill & Melinda Gates Foundation via a $14 million grant, as well as support from the giant pharmaceutical company ‘Pfizer.’

“As a person who was born in one of the poorest countries in the world, I welcome this,” says Samba Sow, Mali’s Health minister. “My elder brother died as a child; more than one of my cousins died as a child. Children die here – and they die early,” the minister bubbled.

A World Health Organisation (WHO) official told Nature that the study results were exciting – but more data were needed to evaluate the approach.

“It goes against dogma at the moment because everyone else is trying to reduce antibiotic use,” says Per Ashorn, who specializes in paediatric infectious diseases at WHO.

In carrying out the latest study, the researchers got the idea from analysis of the pre-emptive use of the antibiotic ‘azithromycin’ in Ethiopian communities affected by the blinding disease known as ‘trachoma.’ That was in the 2000s.

But, for many years, the medical community has been cautious about the advice they give to their patients in regard to the use of antibiotics.

Doctors and patients have always been urged to use antibiotics sparingly, to avoid prescribing the medication to healthy people – and never to use them for conditions which the drugs don’t help, such as the common cold.

For Dr Mario Nyakiha, a clinician in Dar es Salaam, the new findings are proving a point – but bear grave risks. He says the antibiotics – as the new study points out – could indeed reduce infant deaths. But, he noted, “…the risks outweigh the benefits.

“There will be an increase in antibiotics resistance, that’s one. But there could also be an increase in other fungal infections, including meningitis. We can think of other preventive measures apart from mass distribution of antibiotics,’’ Dr Nyakiha suggested in an interview with The Citizen.

The vice-president of Pfizer Vaccines Clinical Research, Dr Charles Knirsch, has downplayed the risks posed by mass distribution of antibiotics.

Most interestingly, though: Pfizer made the antibiotics that were supplied for the study.

Dr Knirsch was quoted by the US-based National Public Radio (NPR) as saying that, “In areas of very low access to antibiotics, there are very low levels of resistance. The risk has to be considered. But it’s a very low risk.”

But, as for Dr Joseph Kiwia from the Regency Medical Centre in Dar es Salaam, the focus should now be on creating a functional health system in efforts to cut down infant mortality.

“Mass antibiotics distribution would lead to resistance which is fatal to our sector! We need an active healthy system,’’ he insisted.

This is not the first time…

This is not the first time that local experts have come out to oppose a study on antibiotics, based on fears of antibiotics resistance. Last year, a review by British researchers who urged doctors to stop telling their patients to finish an entire course of antibiotics was received with caution and uproar by some public health stakeholders in Tanzania and beyond.

They warned that if the message the study contained found its way to local media, it would not augur well with efforts to control the growing trend of antibiotic resistance in the countries where people lack enough health education – and have no strong policies to regulate prescription of medications.

Apparently, 10 researchers from the United Kingdom had published the findings in the British Medical Journal (BMJ), stating that “doctors must stop telling patients to finish an entire course of antibiotics because it is driving antimicrobial resistance.”

In the BMJ article titled ‘The antibiotics course has had its day,’ the experts argued that when a patient takes any antibiotics, this allows dangerous strains of bacteria to grow on the skin and gut – and which could cause problems later. The longer the course, the more the resistance build-up...

“Patients should be encouraged to continue taking medication only until they feel better, to avoid the overuse of drugs,’’ the experts suggested.

But, that was contrary to guidelines of the World Health Organisation (WHO), which say patients taking antibiotics must “finish the course of antibiotics,’’ to avoid triggering more virulent forms of the disease.

Dr Sajjad Fazel, a public health advocate, expressed fears that if the message carried in the study was picked by the local media and highly publicised, “…it would cause a firestorm, causing patients to demand short courses from health practitioners – and making matters worse.

“The scenario in England is quite different from Tanzania and Africa in general. A message such as the one published in the recent antibiotic study in the BMJ could cripple the health system in Africa as it is,’’ he warned.

“Often times in Tanzania antibiotics can be bought over the counter, and many patients self-medicate. As a clinical pharmacist who strives to educate patients to complete their course of medications – and advise doctors to not prescribe antibiotics irrationally – I find the recent study lacking evidence, and needs more research before being incorporated into policy.”

Tanzania launched the ‘National Action Plan to Curb Antibiotic Resistance’ last year with the broader aim of dealing with irrational prescription practices among medics, and establishing strict laws that would stop livestock keepers from using antibiotics as animal feeds!