Bitter Pills:Medicines & The Third World Poor | Page 119

and Pfizer showed a documentary there on the subject.(i07) But few injection givers
come into contact with helpful advice. In the home of one poor family in North
Yemen we witnessed a home injection of procaine-penicillin and streptomycin which
one woman gave another for a cut thumb which had already been well daubed and
protected from infection with gentian violet. Before giving the injection the woman
unwrapped the disposable syringe and left it on the floor. She made no attempt
to cleanse her cousin's arm. This injection of two antibiotics to forestall a possible
infection carried dangers undreamt of by these Yemenis.

ANTIBIOTICS AND DRUG RESISTANCE
The combined injection was of two key drugs, penicillin and streptomycin. These
are relatively inexpensive and therefore used as first line drugs for attacking a range
of bacterial infections. Streptomycin is particularly useful for TB. But if these
antibiotics are over-used the bacteria they attack quickly build up resistance. Bacteria
can make themselves resistant to streptomycin very fast, so the drug becomes useless
for TB sufferers. They then end up payi ng for more costly second-line antibiotics.
Drug resistance presents problems everywhere. But it can make the difference
between life and death in poor countries.
An Indian doctor explains that the use of streptomycin "in combination with
penicillin [ and ] chloramphenicol for ordinary infections is creating increasing
problems for developing countries like ours. Primary resistance of tuberculosis to
streptomycin which is one of the first-line drugs is a calamity. We can't afford
expensive second-line drugs. Further infection of individuals with resistant
tuberculous mycobacteria helps in making the situation worse." <108) A doctor in
Bangladesh confirms that "patients are very likely to die as a result of this"." 091
Despite the obvious dangers, in many Third World countries manufacturers are
marketing products containing streptomycin and other first-line antituberculous
drugs for trivial, unnecessary uses. For example, UNCTAD reports that many cough
and cold remedies containing streptomycin are sold in Nepal, a country where almost
a quarter of child deaths are caused by TB. ("0)
These antibiotic mixtures are more irrational than they may at first appear.
Antibiotics attack bacteria. Colds are caused by viruses. So it is futile to take an
antibiotic for a cold. It is also pointless, and even self-defeating to take antibiotics
as a routine treatment for diarrhoea. The British National Formulary stresses that
"most cases of diarrhoea are not bacterial in origin", but "even when a bacterial
cause is suspected, antibiotics ... should be avoided... because they may prolong
rather than shorten the time taken to control diarrhoea and carrier states". ( ""
(original emphasis)
Yet antibiotics are commonly taken for diarrhoea and non-bacterial infections all
over the Third World. One drug store owner in a large village in Bangladesh told
us that he always recommends the antibiotic Sumycin (tetracycline syrup) for young
children suffering from diarrhoea. Not surprisingly, it is his best selling product
and he orders it frequently. He said that the sales representative for the
manufacturers, Squibb, has never mentioned on his monthly visits that tetracycline
112