Exploring the Antimicrobial Stewardship Educational Needs of Healthcare Students (9) Why are antibiotics overprescribed?

15 June, 2022

In Tanzania the overprescription of antibiotics is a common phenomene both in public and private sectoe and at all levels from dispensaries to national hospitals. In addition the self care practices by obtaining antibiotics from a rapidly increasing number of drug selling outlets in particular in urban areas is very common. On top of this, since a few years there is a rapid rise among clinical practioners and clients of the diagnosis of "UTI", a term now very well known and used by the public. This diagnosis is made by clinicians at facilities both in public and private sector as well as in the drug outlets usually staffed by a pharmaceutical attendant responding to clients complaints which results in swallowing for once or few days swallowing of the commonly used drug for this condition being azithromycin (AZUMO). Without clinical or laboratory evidence in almost all cases of any acute infection of the urinary tract, a strong belief is created that this is the proper way to deal with vague symptoms like belly pain, a feverish feeling or body bad feeling. We see this equally among boys and girls, adult males and females which really make you wonder how is this medically possible. If urine is taken for examination it is rarely midstream and if a few neutrophile cells are seen, it is immediately written as pus cells ++.

Where and how have we lost the assurance of quality by good clinical practice?? We need urgently good clinical, microbiological and in particular health practice behavioural/motivational research to document this, determine underlying factors and suggest solutions. Luckily this has been brought to the attention of the highest level of the Ministry of Health and formal calls for research have been made.

HIFA profile: Eric van Praag is a medical doctor, public health specialist, retired staff Medical School, Muhimbili, Dar es Salaam, Tanzania as well as WHO Zambia and Geneva, FHI360 and UNICEF Tanzania. He currently lives in Tanzania. Professional interests: Health Systems Strengthening, Community Health Care, Disease control. Email address: eric.vanpraag AT gmail.com