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Nigerians Risk Harm from Taking Unregulated Antibiotics - 2003-07-14

In many parts of the developing world, powerful drugs that kill disease-causing bacteria are available from shops selling clothing, candy, or motorcycle parts; or from street vendors. Relatively easy access to medicine might seem like a good thing. But scientists are increasingly concerned that these unregulated drug sellers are contributing to the rise of harmful bacteria that are immune to the effects of these drugs.

Microbiologist Iruka Okeke was born in Britain, but her family is Nigerian. She received most of her education in Nigeria, and much of her research is based there.

She said it's common for people in Nigeria, and in other developing countries, to get bacteria-killing drugs called antibiotics at unregulated shops, or streetside hawkers, rather than from a doctor.

"There's a whole range of reasons. They're in many cases more convenient, closer to the patient, closer in cultural beliefs with the patient…," Ms. Okeke said.

Cultural beliefs are a big factor, she said. While a doctor will look for germs that are causing an illness, patients may believe their illness is due to bad air, spirits, or some other non-scientific cause. Ms. Okeke said the unlicensed drug salesmen are more likely than a doctor to be sympathetic to these explanations.

But Ms. Okeke said it's not a good idea to buy antibiotics from these unregulated sources. She said they often do not pay attention to when drugs expire or are recalled. They generally do not know the proper number of doses a patient should take. And, she said, they are generally not equipped to store antibiotics.

"Most antibiotics should be stored between 20 to 25 degrees centigrade. And to get that temperature in a tropical country you're going to have to have air conditioning. Pharmacists are required to have air conditioning, but unsanctioned providers are not. So if you're buying drugs that have been stored for any length of time in those places, they're almost certainly going to be degraded," she explained. Someone taking degraded antibiotics might get enough so that they don't feel sick anymore. But they might not get enough to kill all the bacteria that are causing the illness. The ones left alive are most likely to be the ones with a genetic trait that lets them survive the antibiotic attack. Those antibiotic-resistant bacteria will multiply, and can then spread to other people.

Ms. Okeke said this can also happen when someone buys antibiotics without checking with a doctor first. Antibiotics only work if a bacterial infection is making the patient sick. "And so if you're taking antibiotics and you don't have a true infection what you're doing is you're exposing all the other bacteria in your body, and there are millions of them, to the antibiotic. And you're selecting resistant strains. Some of these bacteria that you're selecting that are resistant are harmless," she explained.

But, she said, harmless bacteria can pass that resistance trait on to other bacteria that do cause disease. In the long run, that means the antibiotics will become useless.

"Eventually they won't work. And it may not be in you. It may be in your child, it may be in someone else in the community. So it's actually a community problem where an individual is selecting resistance, but the consequences may have to be borne by a lot of other people," Ms. Okeke said.

When asked whether people should turn to traditional medicines instead of misusing antibiotics, Ms. Okeke was cautious. She said most traditional medicines have not been tested to see if they actually work. So someone who tries a traditional remedy might get better, or might not. "In light of the training I've had, what I can say is, if you're sick, go to a doctor or go to a health professional. That is the sort of advice I would give. But I would say, if you want a tonic, or something rather than take an antibiotic, it might be better to take a traditional medicine," she explained.

Microbiologist Iruka Okeke adds that to be sure these useful drugs will work tomorrow, they will need to be used wisely today.