Irrational Use of Antibiotics Reduces Treatment Options

The data showed that out of approximately 29,437 isolates of Escherichia coli bacteria, 10,263 isolates, or 35%, had multiple resistance, while extended resistance was 16% with 4,656 isolates, and comprehensive resistance was about 1% with 378 isolates.

For Klebsiella pneumoniae bacteria, 41% of isolates had multiple resistance, 26% had extended resistance, and 4% had comprehensive resistance, while multiple resistance in Pseudomonas aeruginosa bacteria was 18%.

Dr. Darar Balaawi, a member of the National Pharmacovigilance Committee and a professor and consultant in clinical pharmacotherapy, confirmed that the rise in resistance rates observed in hospitals reflects a gradual decline in the effectiveness of the pharmaceutical arsenal accumulated by medicine over decades.

He explained in a statement to Alrai that some patients with infections that were supposed to be treatable may now require longer treatment periods and more limited drug options due to bacterial resistance to the antibiotics used.

He said, 'The problem is that we treat antibiotics as a consumer good, while they are a therapeutic resource that we must preserve,' stressing that prescribing or using antibiotics without need affects their effectiveness in the future.

In another indicator according to Balaawi, a recent study conducted in a tertiary medical center, which monitored data over nine years, showed an increase in the prevalence of Escherichia coli bacteria producing 'extended-spectrum beta-lactamase' enzymes among urinary tract infection patients from 43.7% in 2014 to 58.9% in 2023. The increase was more pronounced among children, where the percentage went from 41% to 65.4%.

Balaawi pointed out that the problem is not limited to hospitals, as obtaining and using antibiotics without clinical need, along with some patients demanding them based on previous experiences, contributes to enhancing bacterial resistance.

He noted that assigning responsibility to a single party does not reflect the nature of the problem, adding that the crisis is systemic, and we need effective supervision programs on the use of antibiotics in every hospital, clinical pharmacists integrated into healthcare teams, and rapid diagnosis to help the doctor distinguish between bacterial and viral infections before prescribing antibiotics. The National Plan to Combat Antimicrobial Resistance for the years 2023–2025 included goals for expanding surveillance and programs to monitor the use of antibiotics.

The classification of antibiotics was also updated according to the World Health Organization's classification into three groups: 'ACCESS', 'WATCH', and 'RESERVE', with the dispensing of reserve group antibiotics limited to hospitals under specific conditions.

Balaawi believed that the challenge lies in converting plans and instructions into daily practices within healthcare institutions, alongside enhancing infection prevention measures, including hand hygiene, sterilization, and early isolation.

He emphasized the need to shift from focusing on treating infections to enhancing their prevention, alongside investing in clinical pharmacy and integrating clinical pharmacists into intensive care and infectious disease teams to review doses, drug interactions, and the need for continued antibiotic use.

He called for setting measurable national goals to reduce unnecessary antibiotic use, expanding supervision programs in hospitals, and training doctors at the beginning of their careers on rational use, alongside enhancing community awareness.

Balaawi pointed out that preserving the effectiveness of antibiotics is a shared responsibility between the healthcare system, doctors, pharmacists, and patients, warning that continued irrational use means giving bacteria more opportunity to develop resistance and reduce available treatment options in the future.