Bitter Pills:Medicines & The Third World Poor | Page 121

As a result all the key first-line antibiotics are used irrationally throughout the
Third World. The pattern seems to be, when in doubt, prescribe an antibiotic.
A pharmacist in Bangladesh will recommend a penicillin injection for a baby with
nappy rash. Hospital doctors in North Yemen will give penicillin injections to
a breast-feeding mother with sore nipples. In Bangladesh a young boy knocked
down by a motorised rickshaw is prescribed tetracycline (and half a dozen other
drugs) for mild concussion. Even in remote areas of the Amazon, poorly trained
health workers have been distributing tetracycline capsules with apparent total
disregard for the problems of drug resistance. "231
The extent of the over-use of antibiotics is illustrated by the records of drug
consumption from just one health station in Ethiopia over a three month period.
During that time a total of about 100 patients consumed the entire stock of 500
vials of procaine-penicillin, 500 vials of streptomycin, 4,000 capsules of tetracycline
and 2,000 capsules of chloramphenicol. The patients' records show that some
were given streptomycin for coughs, and others simultaneous course of three
antibiotics (chloramphenicol, penicillin and streptomycin) for bronchitis. (l24'
Since both manufacturers and prescribers give too much encouragement to the
indiscriminate use of antibiotics, it is hardly surprising that ordinary people have
come to see antibiotics as panaceas. When her child falls ill, a poor woman in
Bangladesh may well try to save money by going straight to the pharmacy, bypassing the doctor. She remembers that last time the child was ill, the doctor
prescribed ampicillin or penicillin syrup, and the baby recovered quickly. This
time, no matter what is wrong with the child, she buys the same antibiotic. As
soon as the baby seems better, she stops giving it the medicine to save some for
next time. (125)
Most of the Third World poor (and many in the rich world) have no idea that
it is dangerous to take just a few capsules of an antibiotic, or break off a course
of treatment as soon as you begin to feel better. An incomplete course enables
the bacteria to build up resistance and makes outbreaks of drug-resistant disease
a virtual certainty.
In developing countries antibiotics are sold loose on market stalls without packs
or instructions - often illegally. In the open markets in Upper Volta antibiotic
capsules are displayed on huge trays alongside assortments of equally colourful
sweets. They cost about 5p for three and people will buy a single capsule to cure
a headache or stomach pain.(l26> Antibiotics are even sold in incomplete courses
by the pharmacies. In Nepal, for instance, a health worker reports that it is an
everyday occurrence to see people buying two or three capsules of chloramphenicol
or tetracycline when a child has diarrhoea or is feverish. "27) In a number of
African countries, people take the odd penicillin or ampicillin capsule as a blanket
protection against illness, particularly venereal disease. "28)
The inevitable result of this random medication is that reports of drug resistance
are coming in thick and fast from all over the Third World. Since 1972 there have
been reports of chloramphenicol-resistant strains of typhoid from a growing
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