Jordan and the dangers of liberal antibiotic use

asian doctor holding antibiotics capsule pills drugs
(Photo: Envato Elements)
At a time when illness was considered a death sentence, antibiotics (the first of which was penicillin) revolutionized medicine, curing various diseases with little to no side effects. However, another problem, especially in Jordan, has risen with time: the liberal use of antibiotics. اضافة اعلان

In a general sense, antibiotics interfere with vital biochemical processes unique to bacterial cells, making their effect on human cells minimal. 

This interference can affect bacterial reproduction, cellular structure, and integrity or metabolism.

Naturally, bacterial cells evolve to develop mechanisms to resist antimicrobial agents by modifying their metabolic reactions and cellular structures. In turn, a phenomenon called antimicrobial resistance came to be, allowing certain species of bacteria to dodge antimicrobial agents. 

This phenomenon has become a major public health concern. 

Jordan: Space for misuse and overuse
In Jordan, antibiotics are available over the counter, creating a wider space for misuse and overuse. 

A study published in Pubmed in 2020 by DH Abdelqader concluded that most Jordanians resort to self-medication and use antibiotics without a prescription.

The questionnaire used in the study also showed that most participants had poor knowledge of the proper usage of antibiotics and found dangerous practices such as incomplete treatment and unnecessary treatment normal or unproblematic. 

Many people also reported being dissatisfied with a physician that does not prescribe antibiotics. 

The ideal usage of antibiotics
Antibiotics should be used when a bacterial infection is confirmed or strongly suspected. They can also be employed as a prophylactic measure to prevent severe conditions after surgery.

It is important to note that antibiotics are ineffective against viral infections such as the common cold and flu. 

Broad-spectrum antibiotics, which affect various bacterial species, including those beneficial to the human body, can disrupt essential functions like training the immune system, metabolizing food to produce vitamins, and protecting against harmful bacteria.

A disruption to the microbiome
When antibiotics are overused or misused, they kill not only the targeted bacteria but also the beneficial ones, which disrupts the balance of the microbiome.

The microbiome is a term used to describe the trillions of bacteria and other microorganisms that live in our bodies. 

This disruption can pave the way for the proliferation of opportunistic pathogens, which are naturally present in the human body but are kept in check by beneficial bacteria under normal circumstances. 

Serious opportunistic infections include pseudomembranous colitis caused by C. dificile; other infections include fungal infections of the lung, oral cavity, and urinary tract.

Moreover, studies have shown that the overuse of antibiotics can reduce the microbiome's diversity, completely wiping out certain bacterial species. This dysregulates the immune system, as the microbiome plays a crucial role in training it to recognize and respond appropriately to different pathogens. 

Without this training, the immune system may overreact to harmless substances, leading to the development of allergies and autoimmune diseases.

Two studies published in Pubmed in 2018 and 2020 reported that children exposed to antibiotics during their first year had a higher risk of developing multiple conditions such as asthma, allergic rhinitis, food allergies, and hay fever. 

In addition to allergies, the overuse of antibiotics has been linked to an increased risk of autoimmune diseases such as inflammatory bowel disease, rheumatoid arthritis, and multiple sclerosis, to name a few. 

The exact reason why these conditions develop is still being studied. Still, there are multiple indications that the microbiome plays a crucial role in developing and regulating the immune system. Disruption of this balance can lead to an overactive immune system that attacks the body's tissues.

A study conducted in Jordan found that the prevalence of autoimmune diseases is rising, with allergies being the most common.

According to the Ministry of Health, Jordan has a high prevalence of antibiotic resistance, especially in gram-negative bacteria such as Escherichia coli and Klebsiella pneumonia, the spread of these resistant strains can lead to chronic infections that are difficult to treat, and these stubborn infections are becoming an increasingly challenging issue to Jordanian doctors.

The gut knows best
The microbiome is known to play a crucial role in many physiological processes, including digestion, immune function, and even brain function.

Recent research has highlighted the relationship between the microbiome and mood and psychological well-being. In particular, the gut microbiome has been shown to influence the levels of neurotransmitters, such as serotonin, which are crucial for regulating mood and behavior.

Antibiotics can have a significant impact on the microbiome and, consequently, on mood and psychology. 

Broad-spectrum antibiotics can disrupt the delicate balance of the gut microbiome, reducing the diversity of bacteria and altering their composition. 

This disruption can affect the production and regulation of neurotransmitters, such as serotonin, which are crucial for mood and behavior. Serotonin is often referred to as the "feel-good" hormone, as it is associated with feelings of happiness and well-being. In fact, around 90 percent of serotonin is produced in the gut, highlighting the importance of a healthy microbiome in regulating mood. 

Disruption of the microbiome through antibiotics can lead to imbalances in serotonin levels, potentially leading to mood disorders such as depression and anxiety.

Room for hope 
A cross-sectional study published in 2021 concerned with the change in the Jordanian public’s awareness about antibiotics between 2010 and 2018 has shown an improved understanding of certain aspects, such as the use of leftover antibiotics, and improved general knowledge about antimicrobial resistance. 

Awareness about other harmful practices, such as self-medication with antibiotics, was not affected during that period.

To address the issue of overuse and misuse of antibiotics in Jordan, there needs to be tough regulations put in place. 

One possible regulation is to remove the over-the-counter status of antibiotics, which would require patients to have a prescription from a healthcare provider to obtain antibiotics. 

Being a common practice in many countries, the Kingdom could help reduce the amount of self-prescribed antibiotics to a more responsible usage that would require physician recommendation.

However, this also leads to another important part of the issue, managing how healthcare providers contribute to developing antibiotic resistance. 

This can be done by implementing educational programs for healthcare providers on appropriate antibiotic prescribing practices and increasing monitoring and accountability for antibiotic prescribing.

Furthermore, there is a need to improve the quality of data on resistance patterns.

It is also important to acknowledge the role of pharmaceutical companies in perpetuating the problem of antibiotic resistance. 

The profit-driven nature of the industry can incentivize the development and marketing of broad-spectrum antibiotics, which can contribute to the development of resistance. 

Therefore, there is a need for increased regulation and accountability for pharmaceutical companies to promote the development of new antibiotics that are targeted and effective while also promoting the responsible use of antibiotics to preserve their efficacy for future generations.

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