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When child falls ill, don't just rush to pharmacy

 AMR happens when drugs stop working after bacteria develop ways of medicines. [iStockphoto]

Many parents first rush to the pharmacy when their children fall ill. But pharmacists rarely diagnose the problem before selling drugs. When the children get well, most parents stop the dose until the next illness.

Dr Mirfin Mpundu, Director of ReAct Africa, warns that this practice is leading to antimicrobial resistance (AMR), from which many people are dying of drug-resistant infections, including children.

Speaking during the ReAct Africa Conference in Lusaka, Zambia in July, Dr Mpundu said AMR happens when drugs stop working after bacteria develop ways of medicines "and if one has an infection, and the drugs are not working, the person may die."

About 254,000 children aged under five die from AMR annually in the world, according to Lancet, which equates to one child dying every two minutes.

Dr Mpundu says the immune system in children is not fully developed compared to adults, thus exposing them to antibiotics at an early age could lead to resistance. The situation worsens when the said children have not completed their immunisation schedules to develop strong immunity.

Dr Bernard Wambulwa, an infectious disease pharmacist, says children are at a greater risk of AMR as they are the most users of over-the-counter antibiotics.

"Upper respiratory tract infections are very common in children and mothers rush to the pharmacies to get amoxicillin, septrin or other medications over the counter even without knowing the kind of pathogen causing the infection," he says.

Dr Wambulwa advises that one should go to hospital when sick. If an antibiotic is to be given, there ought to be enough evidence that a bacteria caused the infection.

"When you get slight flu, do not rush to get yourself an antibiotic yet we know common cold or influenza is a viral disease and an antibiotic will only help you if the illness is caused by a bacteria. Besides, the flu can clear itself up after five or seven days if you manage the symptoms well," he says.

Some children have been exposed to infections in hospitals - home to infectious pathogens - says Dr Mpundu.

"Most hospitals do not have clean running water and doctors and other medics can easily pass the infection pathogens from one patient to another.

"Many hospitals have no laboratories to test and determine which bacteria is causing the infection to know the right kind of medicine to treat it," he says.

The World Health Organisation (WHO) declared AMR a global concern and the government has been raising awareness and conducting surveillance among children and medics to understand the extent of the problem in Makueni, Kisumu and Isiolo counties.

Although no available data indicates AMR in children in Kenya, Dr Wambulwa calls upon the Pharmacy and Poisons Board to change their strategy in controlling the over-the-counter sale of prescription-only drugs, saying the crackdown on unlicensed pharmacies has been helpful, although most of them that get closed down usually reopen after a while.

Prof Gunturu Revathi, the Head of Clinical Microbiology Diagnostic Laboratory under the Aga Khan University, believes awareness of AMR in children should begin during the ante-natal clinic when the mother is pregnant.

"Mothers should be taught the right use of antibiotics even before they give birth as whatever they take is passed on to the unborn child, and could lead to AMR in the unborn children," says Prof Revathi.

She says most parents may pressure the healthcare provider to prescribe antibiotics, which is more common in private clinics than in public health facilities; therefore, awareness of the long-lasting harmful effects caused by AMR is necessary.

One of the harmful effects of AMR is the need for second-line drugs, according to Dr Wambulwa, which have more side effects, may be more expensive and hard to find in public health facilities, and if not found, then the patient can take longer in hospital managing the same condition and may eventually die.

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