Myths of Antibiotics

       Have you ever see a doctor, expecting antibiotics to be given to treat your common cold or cough? This is a wrong mindset that most people have. Antibiotics, also called antibacterial agents, are antimicrobial medications used in the treatment and prevention of bacterial infection.

Here are some myths to clear your doubts on the use of antibiotics.

MYTH 1: ANTIBIOTICS FOR EVERY AND ANY ILLNESS

         Antibiotics only work against BACTERIAL infections and not VIRUSES. Most coughs, colds and sore throats are caused by viral infections which are self-limiting. If you take an antibiotic when you are actually having a viral infection, the antibiotic will attack the beneficial or natural bacteria in your body. This misdirected treatment can promote antibiotic-resistant properties in harmless bacteria that can be shared with other bacteria. The misuse and overuse of antibiotics can increase your risk of bacterial infections. Therefore, the proper management for cold, flu, cough or sore throat is to take antihistamines for runny nose, antitussive for dry cough, mucolytic or expectorants for productive cough and painkillers for sore throat. If the illness persists or worsens after 2 weeks, it is recommended for you to see your physician.

Antibiotics either:

·         Kill the bacteria by disrupting one of the processes they need to survive.

                                OR

·         Stop the bacterial cells from growing.

What are the differences between bacterial and viral infection?

	BACTERIAL INFECTION	VIRAL INFECTION
Causative agent	Bacteria	Virus
Nature of agent	Most bacteria that are harmless are responsible in breaking down food and inhibiting the growth of bad bacteria.	Require living hosts such as human, plants or animals to multiply.
Type of illness	Ear infection, tuberculosis, skin infections and urinary tract infections	Chickenpox, AIDS, common colds and flu
Self-limiting	Mild infections are self-limiting	Yes
Treatment	Antibiotics	Antivirals

       In some cases, it would be hard to determine whether a bacterium or virus is causing your symptoms. Infections, such as pneumonia (lung infection), meningitis (infection of the tissues that cover the brain and spinal cord) and infective diarrhea, can be caused by either bacteria or virus. Your doctor might take your blood sample to perform a test to determine the causative organism of your illness.

           Bacterial infection, such as sinus infection, could be suspected only if the cold symptoms, such as running nose and congested nose, persist longer than the expected period (10-14 days). Ear pain and new onset of fever after several days of a runny nose is probably due to ear infection.

MYTH 2: YOU CAN STOP TAKING ANTIBIOTIC ANYTIME ONCE YOU GET BETTER

            

              If antibiotics are prescribed to you by a doctor, you need to finish the course of antibiotic even if you feel better to prevent bacterial resistance.

What is bacterial resistance?

             It is the bacteria’s ability to resist the effects of an antibiotic, rendering the antibiotic ineffective. In simpler term, the antibiotics no longer work against them. Bacterial resistance occurs when bacterial strains mutate to reduce the effectiveness of the antibiotic. If you stop taking antibiotics after you get better, the bacteria that have yet to be killed can lead to infection recurrence which can lead to prolonged infection period and more expensive treatments. Therefore, taking a full course of antibiotic is necessary to get rid of the bacteria in your body and prevent the spread of antibiotic resistant bacteria.

MYTH 3: YOU CAN TAKE LEFTOVER ANTIBIOTIC FOR NEXT ILLNESS

            Not every infection is caused by the same bacteria. There is no single antibiotic that is effective against all types of infections. There are certain antibiotics only effective for specific bacteria. Stockpiling antibiotics can lead to misuse of antibiotics, resulting in emergence of bacterial resistance. In fact, there should not be any leftover if you have taken full course of antibiotics treatment. These leftover antibiotics might not work against your current illness and could actually worsen it by delaying proper treatment and allowing the growth of harmful and resistant bacteria. Besides that, the antibiotics will lose their potency and become ineffective if they were stockpiled for extended period of time, especially for the liquid forms of antibiotics.   

MYTH 4: YOU CAN SHARE ANTIBIOTICS OR TAKE ANTIBIOTICS WHICH ARE PRESCRIBED FOR OTHERS

            You should not share or take antibiotics which were being prescribed for others. Antibiotics are prescribed for your specific illness and doctor also dosed it for your condition. Furthermore, there are people totally unaware that they are allergic to certain antibiotics. The most well-known antibiotic allergy is penicillin allergy. If you have not taken antibiotics before, you will need to watch out for allergic reactions, such as rashes, difficulty breathing or itchy skin. Once you notice these signs, you should stop these medication and consult the doctor immediately. The doctor will change the antibiotics accordingly for you.

              There is a case that a nineteen-year-old girl took some of her friend’s antibiotics and was admitted to ICU burn unit due to serious reaction to the medication. This reaction, also known as Steven-Johnson syndrome, in which the skin and mucous membranes burn, blister and shed. 70% of her body was damaged and it took a really long time to recover from the burns.

              Besides that, inappropriate use of antibiotics can lead to increased resistance, making bacteria stronger and harder to fight in the future. Now, you have known a lot of reasons of how "superbugs" come from! 

MYTH 5: ANTIBIOTICS HAVE NO SIDE EFFECTS

            

           Antibiotics have mild side effects and these side effects vary according to the classes of antibiotics. Mild side effects, including rashes, diarrhea, nausea and vomiting, will resolve on its own after stopping of antibiotics but severe side effects, such as anaphylactic shock, requires immediate medical attention. If you experienced any discomfort after taking antibiotics, you should inform the doctor. The doctor will treat the side effect if necessary, adjust the dose or switch to a different antibiotic. Any antibiotics should not be stopped without a doctor’s approval.

MYTH 6: ANTIBIOTICS THAT KILL MORE BACTERIA ARE BETTER

            

        An antibiotic that can kill different types of bacteria are known as broad-spectrum antibiotic. These antibiotics are usually reserved for:-

·         Bacteria which are resistant to narrow spectrum antibiotics.

·         Super-infections where multiple types of bacterial infect the patient.

·        Empirical treatment where the causative bacteria is unknown and delay in treatment would be fatal.

      Misuse of broad-spectrum antibiotics in either outpatient (prescribing the antibiotics to patients and allowing them to go home) or inpatient (prescribing the antibiotics to the patients in wards) settings will promote the emergence of antibiotic resistance. Therefore, unnecessary administration of broad-spectrum antibiotics is strongly prohibited. This information is useful for both patients and physicians! 

  

How to prevent antibiotic resistance?

1.      Take the antibiotics exactly as the doctor had prescribed. Do not skip dose and complete the entire course of treatment, even when you start feeling better.

2.      Once the prescribed course of treatment is completed, discard the leftover antibiotics by returning them to the pharmacy for safe disposal. Never take the leftover antibiotics for a later illness.

3.      Never take antibiotics prescribed for someone else other than yourself.

4.      Never share the prescribed antibiotics with the other people.

5.      Do not ask your doctor to give you antibiotic prescription. Ask your doctor for advice on how to relieve the symptoms.

6.      Prevent infections by practicing good hand hygiene and getting recommended vaccine.

Authors:

1. Jamie Lim Jo Shin

BPharm (Hons) (IMU)

2. Lau Hie Hie

BPharm (Hons) (IMU)

Editors:

1. Ong Jijien

BPharm (Hons) (IMU)

2. Jordy Wong Der Yuan

BPharm (Hons) (IMU)

Medication: Paracetamol

Examples of branded paracetamol: Panadol®

Examples of generic products for paracetamol

Introduction

       "Panadol^®", which consists of paracetamol (name used in UK) or acetaminophan (name used in US), is a commonly used brand in the current market. Almost everyone is aware of the existence of this medication due to its extensive advertisement in the television and internet with its original brand name "Panadol^®". But how well do you know about this medication?

       Paracetamol, which is usually available as a 500mg/650mg tablet, syrup or suppositories, is indicated for fever or as a mild painkiller. Paracetamol may be combined with other medications to provide a 3-in-1 effect, for example, with pseudoephedrine and chlorpheniramine for congested and running nose symptoms, or with codeine/tramadol as a stronger painkiller.

       For adolescents (age more than 12 years old) or adults with normal kidney and liver function, the maximum tolerable dose of paracetamol will be 4000mg or 4g (e.g. 2 tablets of 500mg paracetamol, 4 times a day or 1 tablet of 650mg paracetamol 6 times a day). Paracetamol can be taken with or without food. For infants to children dosing, please refer to the external labeling of the paracetamol syrup.   

        I believe this brief introduction provides you a better understanding on paracetamol. Now, I would to clarify some of your doubts and myths regarding this medication, namely paracetamol.

Doubts and Myths

1. Will all painkillers, including paracetamol, lead to gastric problems?

Painkillers, such as non-steroidal anti-inflammatory drugs (NSAIDs), will have a higher risk of gastric problems due to their acidic properties in nature. However, paracetamol is a very weak acid compared to NSAIDs and hence it is very unlikely to cause gastric problem even it is being given on an empty stomach.

2. Will long-term intake of paracetamol damages the liver and kidney?

There is a report showing that paracetamol under recommended dosing can cause liver dysfunction which is very rare (less than 1/10000). As long as paracetamol is taken as instructed, it will not lead to liver damage. There are no evidences showing that paracetamol can lead to kidney damage. However, paracetamol should be used with caution in patient with impaired liver and/or kidney function. 

3. Why do I develop rashes after I take paracetamol?

There may be chances that you will be allergic to paracetamol although the chances are very rare (less than 1/10000). It is considered as mild allergy, if you develop rashes after taking it. For a more severe allergic response, the patient might develop difficulties in breathing. For patients who might develop mild allergies, it will be advisable to choose other medications over paracetamol as discomfort may still occur.

 4. Will paracetamol stay in my body forever?

The elimination half-life of paracetamol varies from 1 hour to 3 hours. But first of all, what is half life? Elimination half-life basically refers to the time required to eliminate half the amount of drug from the body (eg. from 100% to 50%). It takes around 5 half lives to eliminate almost all of it. So hence, paracetamol takes around 5 to 15 hours to be completely being eliminated from the body. Therefore, the myth regarding that paracetamol will stay in the body forever is not true!  

The elimination half-life of paracetamol (1 to 3 hours) also explains why the patient has to take paracetamol every 4-6 hours. For medication with long elimination half-life (eg. 12-18 hours) may explain why that particular medication just requires once daily intake.

5. Will paracetamol cause cancer?

There are researches showing paracetamol could post a risk in developing blood cancer but it is yet to be confirmed. 

6. Can I take paracetamol if I am pregnant or breastfeeding?

Paracetamol is categorized as Pregnancy Category A. This means that Paracetamol has been taken by a large number of pregnant women and women of childbearing age without any proven increase in the frequency of malformations. Hence, it is considered safe to be taken as normal dose by pregnant woman, regardless of the pregnancy trimester.

Paracetamol will be excreted in breast milk but the amount exposed to the infant is less than 0.1% of a single dose of paracetamol 500 mg and as 0.04 to 0.23% of a single 650 mg dose. Hence, as long as the breastfeeding mother is taking the paracetamol without exceeding the recommended dose, it will not be a risk to the breastfed infant.

7. What is the difference between Panadol^® and other brands of paracetamol?

Panadol^®, is the original brand of paracetamol, it is manufactured and patented by GlaxoSmithKline (GSK). Other brands, such as Paracil^®, Dymadon^®, Febridol^® and Paralgin^®, are generic brands patented by other companies. All of them contain paracetamol as the active ingredient but their excipients (inactive ingredients, such as preservatives) can be different. The generic brands of paracetamol have to meet with the requirement of bioequivalence before they are released into the market. If two products are said to be bioequivalent, it means that they would be expected to be, for all intents and purposes, the same.

8. What should I do if a person exceeded the recommended dosage of paracetamol?

Paracetamol overdose may cause liver failure which can lead to liver transplant or death.

If an overdose is confirmed or suspected, the National Poisons Centre should be contacted immediately for advice. The patient should also be sent to a hospital as soon as possible, even if there are no symptoms of overdosing as there is a risk of delayed, serious liver damage.

National Poisons Centre (in Malaysia)

Office Hours              : 1-800-88-8099 / +604-657 0099
(Monday-Friday: 8.10am-5.10pm)

After Office Hours    : +6012-430-9499

(Including weekends and public holidays)

The Author

Jordy Wong Der Yuan

BPharm (Hons) (IMU)

Date: 27/3/2016

Editors

Chang Jen Nee, Ong Jijien

First and Foremost

This blog consists of a group of passionate soon-to-be-graduated pharmacy students sharing their views on certain medications and supplements.

A one stop place to clear your doubts on myths and knowing certain facts that can be useful to improve your understanding on how to use your medications and supplements with its optimal effects and minimal risks. =)