Standardization and better information can reduce antibiotic resistance
ABACUS II project
Antibiotics are too often used incorrectly. This contributes to antibiotic resistance, a growing problem on a global scale. More attention should be devoted to the appearance of medicines. This creates clarity and can reduce misuse, argue researchers from the ABACUS II consortium in the Lancet Global Health.
Antibiotics work very well against bacterial infections. But they are often used incorrectly. For example, people take the wrong antibiotics against an infection with a certain type of bacteria. They also use antibiotics against an infection or inflammation that is not caused by bacteria, or as a painkiller for menstrual pain or muscle pain. This happens on a large scale, especially in lower and middle income countries. And that is a problem, because it contributes to antibiotic resistance. This means that bacteria adapt in such a way that antibiotics lose their effectiveness. Antibiotic resistance is a very urgent and global problem that is growing every year. Researcher Annelie Monnier and medical microbiologist Heiman Wertheim of Radboud university medical center argue that the recognizability of different medicines plays a role in the (in)correct use of antibiotics. According to them, more attention to the appearance of medicines can reduce antibiotic resistance.
QR-codes on packaging
The researchers evaluated antibiotic use in three Asian and three African countries. This revealed that antibiotic misuse is widespread. The names under which antibiotics are known is one of the reasons behind this misuse. For instance, in Vietnam, capsule is the literal translation of one of the words for antibiotics. In Mozambique and Ghana this is the case for red-yellow; the colors of a capsule containing a commonly used antibiotic. But not every capsule contains an antibiotic or the same antibiotic. For example, two different types of antibiotics that work against completely different types of bacteria are both contained in red-yellow capsules. In addition, not every antibiotic comes as a capsule, as many are sold as tablets.
‘That is why we need to move towards standardization and better information for users’, says Monnier. ‘Consistent use of colors and symbols on pills can help. Logos and QR codes on the packaging are also good options. Particularly because medication often comes without an information leaflet in these countries. Such a QR code should refer to a website with information about the drug. Stickers placed on medication packaging could serve such a purpose. This approach is probably easier and quicker to implement than modifying the pills themselves. You can already pay with QR codes on the market in Thailand and Bangladesh, so they already use this technology.’
Clarity helps
These measures should be implemented worldwide. A huge operation, right? ‘Peanuts compared to the magnitude of the problem and the costs associated with it’, says Wertheim. ‘And I am convinced that it is feasible. For example, look at the corona pandemic. We were able to achieve so much worldwide in a short period of time. That should also be possible for this silent pandemic of antibiotic resistance.’
The researchers are in contact with the authorities involved, such as regulators and drug manufacturers. ‘It is a slow process’, says Wertheim. ‘Until recently, they said: all we can do is put a warning on the box…. We think that they can do more. As with so many things, clarity is key. When you provide clarity, people begin to understand it and will be more able to use medicines correctly.
About the publication
This article was published in the Lancet Global Health: Is this pill an antibiotic or a painkiller? Improving the identification of oral antibiotics for better use. A.A. Monnier, N.T.T. Do, K.P. Asante, S. Afari-Asiedu, W.A. Khan, K.M., E. Sevene, T.K. Tran, C.T.K. Nguyen, S. Punpuing, F.X. Gómez-Olivé, H.R. van Doorn, C. Caillet, P.N. Newton, P. Ariana, H.F.L. Wertheim, on behalf of the ABACUS II consortium. DOI: 10.1016/S2214-109X(23)00258-9.
ABACUS project 