Antimicrobial resistance (AMR) continues to be a pressing global health concern, with the misuse and overuse of antimicrobial agents playing a significant role in fuelling this growing crisis. The phenomenon of AMR, where bacteria and other microbes become resistant to the drugs designed to kill them, poses a grave threat to human health, rendering once-treatable infections potentially deadly. This resistance emerges due to selective pressure caused by the inappropriate use of antimicrobials, including irrational prescribing and dispensing practices.
Nigeria stands at a crossroads, facing the critical challenge of irrational prescribing and dispensing practices that fuel the growth of drug-resistant pathogens. The indiscriminate use of antimicrobials, driven by a variety of factors, poses a significant threat to public health and the effectiveness of medical treatments. The nation must confront this issue head-on to safeguard its citizens’ health and secure a future where antibiotics remain effective.
Antimicrobial resistance is not a new phenomenon, but the scale of its consequences has reached alarming heights. The root cause lies in selective pressure – the phenomenon where microbes evolve to survive the onslaught of antimicrobial agents, rendering these drugs increasingly ineffective over time. Two major contributors to selective pressure are irrational prescribing and dispensing of antimicrobials. Nigeria, like many other countries, grapples with these challenges, which intensify the global threat of AMR.
The misuse and overuse of antimicrobials arise from a multitude of sources. Examples of irrational prescribing include administering antimicrobials when they are unnecessary, using incorrect drugs or doses, or employing broad-spectrum medications when more targeted options are available. On the dispensing end, giving incomplete courses of medication, inadequate patient counselling, and selling antimicrobials without prescriptions for personal gains further exacerbate the problem.
These practices are distressingly common, with estimates suggesting that over half of all medicines worldwide are prescribed, dispensed, or sold inappropriately. In the case of antibiotics, up to 50% of prescriptions are unnecessary or not optimally effective, according to the World Health Organization (WHO).
A significant challenge in curbing irrational antimicrobial use in Nigeria is the pervasive influence of informal medicine providers. In low- and middle-income countries, many people rely on street vendors and unregulated drug shops for their medical needs. This uncontrolled environment is a breeding ground for misuse and poor quality control, with antibiotics often sold without prescriptions, and doses tailored to customer demand rather than medical necessity.
The link between knowledge and practice is a pivotal one. While inadequate training, limited access to information, and a lack of standard guidelines contribute to improper prescribing and dispensing, other factors transcend mere knowledge.
Healthcare providers may possess the correct information but not necessarily translate that into proper practice. Fears of clinical outcomes, litigation, and patient dissatisfaction, as well as peer pressure, economic incentives, and patient demands, play a substantial role in shaping their decisions. Profit-driven motives sometimes overshadow optimal medical judgment, leading to overprescribing and dispensing of antimicrobials.
Education emerges as a powerful tool in battling AMR. Educational interventions, particularly when introduced early in a provider’s career, are crucial for shaping behaviour. Integrating rational medicine use and AMR topics into both pre-service and in-service training programs can drive lasting change. These efforts should encompass a range of strategies, from behaviour change communication to regulatory enforcement, peer interactions, outreach, and incentives.
Managerial interventions also hold potential. Implementing standardized treatment guidelines, supervising clinical practices, and conducting medicine use evaluations can help guide appropriate prescribing and dispensing decisions.
A robust regulatory framework is vital to achieving rational prescribing and dispensing practices. Regulations must limit over-the-counter availability of antimicrobials, control drug seller practices, and eradicate unhealthy financial incentives for prescribers and dispensers. Effective enforcement is essential to ensure compliance with these regulations and thus drive positive change.
As Nigeria grapples with its own unique challenges in the battle against AMR, a multifaceted approach is essential. Improved education, robust regulation, and strategic managerial interventions are critical to breaking the cycle of irrational prescribing and dispensing. Only by addressing these underlying issues can Nigeria hope to safeguard the effectiveness of antimicrobial treatments, protect public health, and secure a healthier future for its citizens.
Okeke writes from the Centre for Social Justice (CSJ) Nigeria
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