58 Where There Is No Doctor 2011
IMPORTANCE OF LIMITED USE OF ANTIBIOTICS
The use of all medicines should be limited. But this is especially true of antibiotics,
for the following reasons:
1. Poisoning and reactions. Antibiotics not only kill bacteria, they can also harm
the body, either by poisoning it or by causing allergic reactions. Many people die each
year because they take antibiotics they do not need.
2. Upsetting the natural balance. Not all bacteria in the body are harmful. Some
are necessary for the body to function normally. Antibiotics often kill the good bacteria
along with the harmful ones. Babies who are given antibiotics sometimes develop
fungus or yeast infections of the mouth (thrush, p. 232) or skin (moniliasis, p. 242). This
is because the antibiotics kill the bacteria that help keep fungus under control.
For similar reasons, persons who take ampicillin and other broad-spectrum
antibiotics for several days may develop diarrhea. Antibiotics may kill some kinds of
bacteria necessary for digestion, upsetting the natural balance of bacteria in the gut.
3. Resistance to treatment. In the long run, the most important reason the use
of antibiotics should be limited, is that WHEN ANTIBIOTICS ARE USED TOO MUCH,
THEY BECOME LESS EFFECTIVE.
When attacked many times by the same antibiotic, bacteria become stronger and
are no longer killed by it. They become resistant to the antibiotic. For this reason,
certain dangerous diseases like typhoid are becoming more difficult to treat than they
were a few years ago.
In some places typhoid has become resistant to chloramphenicol, normally the
best medicine for treating it. Chloramphenicol has been used far too much for minor
infections, infections for which other antibiotics would be safer and work as well, or for
which no antibiotic at all is needed.
Throughout the world important diseases are becoming resistant to antibiotics—
largely because antibiotics are used too much for minor infections. If antibiotics
are to continue to save lives, their use must be much more limited than it is at
present. This will depend on their wise use by doctors, health workers, and the people
themselves.
For most minor infections antibiotics are not needed and should not be used.
Minor skin infections can usually be successfully treated with mild soap and water, or
hot soaks, and perhaps painting them with gentian violet (p. 370). Minor respiratory
infections are best treated by drinking lots of liquids, eating good food, and getting
plenty of rest. For most diarrheas, antibiotics are not necessary and may even be
harmful. What is most important is to drink lots of liquids (p. 155), and provide enough
food as soon as the child will eat.
Do not use antibiotics for infections the body can fight successfully
by itself. Save them for when they are most needed.
For more information on learning to use antibiotics sensibly, see Helping Health
Workers Learn, Chapter 19.