The document discusses the indiscriminate use of antibiotics in Nigeria and the growing problem of antibiotic resistance. It summarizes how antibiotics revolutionized medicine but are now facing resistance due to overuse and misuse. Specifically, it notes that many Nigerians engage in self-diagnosis and treatment with antibiotics, abuse antibiotics for minor issues like diarrhea, and do not complete full treatment courses. This antibiotic misuse has led to increased resistance in bacteria like MRSA. The document calls for public education campaigns and limits on antibiotic sales to curb further resistance, which could enable new pandemics of resistant bacterial infections.

1. INDISCRIMINATE USE OF ANTIBIOTICS AMONGST NIGERIANS
Sir Alexander Fleming's discovery of penicillins in 1928 revolutionalized the treatment of infections
and laid the foundation for subsequent research and discovery of other antibiotics. Ever since, antibiotic
use has become a mainstay in the treatment of minor and major virulent bacterial infections. Prior to Sir
Fleming's discovery, humans were susceptible to treatable infections like cholerae, tuberculosis,
syphilis and buboes. Suffice to say, while the 20th
century witnessed a fight against bacterial infections
and eradication of virulent viral infections, the current battle we face is a resurgence of bacterial
infections easily treatable in the past and are presently resistant to common prescribed for their
treatment. These bacterial infections are increasingly becoming difficult to treat and reasons for this
resistance are not unrelated to the abuse of antibiotics by Nigerians. Doctors, health professionals and
the general public are guilty of this abuse and there is a need to re-educate ourselves in lieu of the
recent COVID-19 pandemic and other endemic infectious diseases like Lassa Fever and malaria.
How should antibiotic use be decided? An ideal algorithm in the clinical assessment of a patient with
suspected infection is an individual who presents to his general practitioner, after elciting a thorough
history and examination of the patient, thereafter an objective assessment of the patient is undertaken
to confirm the diagnosis and then appropriate treatment is initiated based on the results of the
investigation. For example, a case of Mr. A with a sore throat is managed by the physician taking a
history and performing an examination, then a throat swab and initiate the patient on an antibiotic that
has a wide coverage against possible bacteria that are known to reside in the throat. This is done
pending the return of the results and then a prompt switch to the antibiotic the bacteria is sensitive to.
However, constraints such as time, cost of testing and easy availability of cheap antibiotic choices have
ensured that most physicians bypass investigating and requesting for microbial analysis.
Also, in a population like ours where most persons practice self-diagnosis and indulge in self-treatment
until the situation becomes dire, there is a need to highlight the dangers of antibiotic abuse. Cases of
abuse within the population include the use of tetracycline and flagyl to treat diarrhea and applying
antibiotics over wounds. These cases abound and increasingly underscore the need for us as a society to
protect our guns and bullets against bacterial organisms and not enable them develop bullet proof vests.
Why is proper use of antibiotics important and why should antibiotic misuse and abuse be discouraged?
Antibiotics are medications that act by targeting certain regions on bacterial cells and destroying or
limiting its growth through this mechanism. Appropriate use of antibiotics includes prescribing a
medication that a bacterial organism is sensitive to and will be effectively killed during treatment. In
addition, ensuring that the duration and course of use of the antibiotic is completed and not
discontinued on the basis that one has experienced relief from symptoms. Simply put, misusing and
abusing antibiotics enables bacteria organisms to develop resistance by undergoing a mutation or
change in its morphology thereby rendering the antibiotic useless when next it is administered.
Are there cases of recent antibiotic resistance? Definitely, most hospitals are fertile grounds for a strain
of bacteria known as Methicilin-resistant Staphylococcus aureus (MRSA). Health professionals are
vectors of this bacteria organism. How did MRSA become so virulent? Reaserch has shown that it
developed following the same pattern of abuse. Methicillin and other first generation penicillins were
readily available, prescribed and dispensed at will by physicians and other health workers and with this,
Staphylococcus aureus species which were initially sensitive to this antibiotic developed resistance and
have today become every doctor's nightmare. There are other bacterial organisms and their prevalence
continues to grow.

2. Education and public awareness is needed. Doctors, nurses, pharmacists and other health workers
through their various guilds and association must embark on an internal audit and re-education to
ensure everyone is aware of the dangers of antibiotic abuse. Thereafter, a cohesive effort and campaign
to enlighten the public on dangers of antibiotic abuse. A comprehensive national plan must be initiated
to radically limit the sale of antibiotics by roadside opportunists or in places other than a registered
pharmacy. It is our duty as individuals to safeguard the health of our nation by ensuring the safest
practices. Negligence and lack of attention to continued antibiotic abuse will lead us into the next
pandemic which will be against resistant and virulent strains of common bacterial organisms.
Antibiotic resistance is growing and we need to act now.