SINGAPORE: It started with a fever. To fight off the infection, Madam Siti Hajar had to rely on antibiotics, as her immune system was weak owing to her diabetes.
But even when she returned to work, she did not feel any better. In fact, her vision began to be affected. So the next day, she went to Changi General Hospital’s accident and emergency department.
“I only remember going to hospital and then registering and seeing the nurse, and from there, I can’t remember anything else,” she told the Mediacorp programme Talking Point. (Watch the episode here.)
After admission, she was diagnosed with a strain of klebsiella pneumoniae that was resistant to multiple antibiotics. That bacterial infection in 2016 left her blind and in embattled health as it spread to her other organs.
Since their discovery, antibiotics have been wonder drugs for millions of patients in the fight against diseases. But they could not help Mdm Siti, 45, who is now living with the effects of a superbug infection.
4 IN 5 WRONGLY THINK THEY CURE COLDS
Like her, one in nine hospital patients here have now been infected by superbugs, bacteria that have become invulnerable to antibiotics over years of exposure.
Worldwide, overuse of antibiotics has led to the rise of antimicrobial resistance. And in Singapore, the problem is compounded by a lack of knowledge of how these drugs work.
Research done by public health experts has found that 78 per cent of Singaporean patients think antibiotics cure infections like common colds and sore throats.
And 66 per cent also believe that antibiotics help these upper respiratory tract infections, which are commonly caused by viruses, to heal faster.
That is why a third of patients expect to be prescribed these drugs - which work only against bacteria, not viruses - when they visit their general practitioners. And if these are not given, some patients would visit another doctor.
Family physician Kelvin Goh from the Northeast Medical Group has faced such pressure from patients, some of whom may insist on antibiotics owing to a “bad experience”.
“They may have seen a doctor for a viral infection. They were told (they) didn’t need antibiotics and subsequently developed a bacterial infection that necessitated either hospital or specialist care,” he explained.
TEST BEFORE PRESCRIBING
The way to distinguish between bacterial and viral infections, he said, is through a good clinical history and good physical examination, supplemented by blood tests and other culture infection tests.
A minority of infections are caused by bacteria, noted Assistant Professor Mark Chen from the National University of Singapore’s Saw Swee Hock School of Public Health, and “some doctors may prescribe antibiotics because they’re worried about missing these respiratory infections”.
But doctors should be more willing to take swabs and do simple tests instead, highlighted Dr Goh.
“We need to educate both the professionals and the public. The doctors must gain the patients’ trust,” he added. “(Only then would) the patient take the advice of the doctor that … no antibiotic is needed.”
If all else has failed, Dr Goh has given these drugs to patients who asked for them, “but we’ll tell them clearly that (they have) a viral infection”.
There are patients, he said, who obtain antibiotics online or from overseas if they cannot get them from any one of the 2,600 GPs here.
While such behaviour is not common, Talking Point did find a number of websites claiming to be online pharmacies – operating outside Singapore – that sold these drugs, allowing patients to get them without prescription.
Though antibiotics cannot be bought over the counter here, patients could still buy them on established platforms like eBay and Carousell, and have them delivered to their home.
WHEN EVEN A CUT BECOMES DEADLY
But the consequences of misusing and developing a resistance to these drugs can be “very worrisome”.
For one thing, the discovery of new antibiotics has slowed in the past few years because the endeavour “is no longer profitable”, said Dr Andrea Kwa, a clinician scientist and specialist pharmacist (infectious diseases) at the Singapore General Hospital.
Resistance to the new drugs occurs within two to three years now, which is “way shorter than their patent period”, she explained.
“Simple procedures like hip replacement, appendectomy (and) emergency caesarean may get more and more difficult to perform, because the infections that could come about as a complication can be more resistant,” she added.
It could get worse if no antibiotic will be effective.
WATCH: "It affected my whole life" (2:28)
Associate Professor Hsu Li Yang, who leads the Saw Swee Hock School of Public Health’s Antimicrobial Resistance Programme, said:
We’re concerned that … people with the simplest types of infections, like (from) a prick on a rose thorn or cuts, can die.
To prevent the build-up of bacterial resistance, the development of new drugs must be accelerated or the improper use of antibiotics must be reduced, he said, citing the example of patients with viral infections.
“We can also increase vaccination, even (against) conditions like influenza,” he added. “If patients do not present (themselves) at the doctor’s with coughs and colds, then the doctors won’t prescribe antibiotics, so … we also reduce the antibiotic pressure overall.”
To help stop the rise of superbugs in hospital, Dr Kwa has a team monitoring antibiotic use and also developing counter-strategies, such as by designing tests of antibiotic combinations if an individual drug is not useful.
As new cases start to reveal the effects superbugs can have, the war against them is likely to intensify.
Mdm Siti is already one of the casualties. “This bacterium (klebsiella pneumonia) has affected my whole life,” she said. “Now I’m like a child, a toddler learning how to walk … how to carry on with life.”
Watch this episode of Talking Point here. New episodes air on Mediacorp Channel 5 every Thursday, 9.30pm.