Too many drugs, too few cures

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Ria Pane took her 7-year-old daughter Kezia to a doctor in Jakarta to check on her fever and sore throat, and was prescribed seven drugs, including antibiotics and medicine to prevent febrile seizures.

Experts say it was another classic, but only too common, case of over-medication, or prescribing drugs patients do not need. Here, the antibiotic was unnecessary, as was the drug to prevent febrile seizures, as the child had no history of such attacks, said several pharmacists and doctors.

Experts warn that driven by profits from selling medicine, some doctors from Jakarta to Hong Kong are over-prescribing medicines, a practice they say will be disastrous in the longer term.

"Polypharmacy (over-medication) is very popular here, it means they use a lot of medicines which are unnecessary, like giving you many types of antibiotics for a cold," says William Chui, honorary associate professor at the Clinical Trials Center attached to the University of Hong Kong.

"Every time they sell a drug, they get a profit, it is a profit motive. When they give lots of medicine, parents feel happier, more happy than when they are told to go home to sleep."

Using a mix of potent drugs to treat common infection is leading to more cases of drug resistance. Reuters

The consumption of multiple drugs triggers drug reaction and unpredictable side effects. Worse, it gives rise to bacterial resistance.

The most recent example of growing resistance involves the drug oseltamivir, which researchers in the United States found was now ineffective against 98 percent of the H1N1 seasonal human influenza virus strains.

Oseltamivir is known by the brand Tamiflu and manufactured by Roche AG.

Oseltamivir is also recommended as a first line of defense against the H5N1 bird flu virus in case it triggers a flu pandemic and experts are now questioning how well, and how long, the drug will stand up against the H5N1 virus.

Apart from eventually reducing the effectiveness of drugs, exposing bacteria and viruses to drugs unnecessarily also has other serious consequences.

"They harm the patient. The more drugs, the worse the compliance, especially for old people. They fall easily because of drug interaction and side effects. They get dizzy, suffer hypotension, it is something we don't recommend," Chui says.

Doctors in Indonesia often prescribe antibiotics to patients suffering a common cold when such drugs are only to be used for bacterial infections.

"Most parents rush to treat symptoms, not the disease. Doctors may feel pressure to give treatments, even when it is not necessary or in the best interests of the child's health," says Purnamawati S. Pujiarto, a pediatrician promoting a more informed use of drugs in Indonesia.

Experts say such a mentality has led not only to polypharmacy, but also the use of compounding medicine, known in Indonesia as "puyer".

Compounding medicine is the practice of crushing different drugs into a powder in a bowl and dividing it into small sachets. Sometimes it is mixed with syrups.

It is carried out under strict guidelines in some countries but in Indonesia, it has been used liberally for decades, particularly to treat health problems in children.

Experts warn this practice could result in errors as the drugs may not be evenly divided or pharmacists may not clean the bowl thoroughly, leaving residues from previous prescriptions.

"The issue is not 'puyer' itself but the competence and knowledge," says Iwan Dwiprahasto, a professor at Gadjah Mada University in Yogyakarta and chairman of the Indonesian Pharmacologist Association. "The compounded form makes patients unaware they have consumed many drugs as it looks like a single medicine."

In Hong Kong, Chui and his colleagues recently discovered widespread abuse of carbapenem, a class of the powerful, broad-spectrum antibiotic in private hospitals.

This class of antibiotics is recommended as a prophylaxis for major procedures, like colorectal operations, but pharmacists found they were given to patients even for minor procedures.

"Alternative prophylaxis requires three doses a day, but this is just one dose daily. Private hospitals use this as it's very convenient and it's broad spectrum so it can block all infections," says Chui.

"But what we are most afraid of is resistance, especially with the (bacteria) stenotrophomonas maltophilia. If you abuse carbapenem, this bacteria will get more resistant."

Stenotrophomonas maltophilia is a bacteria that causes uncommon infections that are difficult to treat, like pneumonia, urinary tract infection or blood stream infection.