Antibiotics are powerful drugs primarily used to treat infections caused by bacteria and which save millions of lives every year. Misuse and overuse, however, can lead to the development of antimicrobial resistance (AMR), making it harder to treat infections, with some becoming untreatable thus increasing the risk of death.
To help the public and young people use antibiotics properly, the Thai Health Promotion Foundation (ThaiHealth), Thai Drug Watch and their networks have launched a campaign aimed at developing health literacy, especially improving awareness and understanding of the appropriate use of antibiotics and the dangers of AMR and its consequences.
“Many Thais still misunderstand how antibiotics are used to treat an illness. This can lead to the emergence of AMR and that affects treatment in the long run,” ThaiHealth’s deputy chief executive officer Dr. Pairoj Saonuam, told participants at the 5th National Forum on AMR, on the theme “One Health, One Future: Act now on AMR”.
A survey supported by ThaiHealth, in response to Thailand’s Second National Action Plan on AMR 2023-2027, revealed that less than half of surveyed respondents (46%) understood the proper use of antibiotics to treat bacterial infections. Factors causing them to fail to complete their antibiotic course include missing doses (54.43%), inconvenience of carrying medicine from place to place (32.71%) and medication timing not matching working time (14.64%).
To illustrate the importance of proper antibiotic use and the impact of AMR, ThaiHealth and its alliances have provided education, resources and creative activities to make the public more ‘antibiotics aware’. They have also created a mechanism to improve antibiotic dispensing practice. Making AMR a core component of education in the veterinary sector and agricultural practice is also a key focus to help avoid the use of antibiotics as a feed additive to accelerate growth, a practice that may contribute to the emergence of AMR.
“We have worked hard to help the public, in particular secondary school students, become health literate, so they are able to use antibiotics correctly and fully understand the factors that drive AMR,” Dr. Pairoj said, adding that the government’s measures to build a sustainable work system in the manufacturing industry are also instrumental in combating AMR in the long term.
Effective communication is key to success
Assoc. Prof. Narumon Arunotai of Chulalongkorn University’s Social Research Institute noted that sickness and treatment are unique from person to person. People’s decisions to use antibiotics to treat an illness are often affected by social structure and environment as well as value.
“For example, when manual workers, who work very hard, become ill, they need to recover quickly. This is because the working conditions often make it difficult for them to take time off sick as they will lose their wages. Some misuse antibiotics to speed up their return to the workplace. Many don’t complete their courses of the medicine, which triggers the development of AMR,” she said.
People who live in remote areas and the marginalized, she added, may need to buy antibiotics from a grocery store in a local market to cure them when they are sick, usually because of the long journey to a hospital in town.
To promote the appropriate use of antibiotics for the public, Narumon has long urged the state agencies responsible for designing the work system to study the behaviours, lifestyle and living limitations of people in different groups.
This can enable authorities to create an effective work system and design educational tools and materials suited to the lifestyle and behaviors of each group, she said.
She is also calling on pharmacists in local drug stores to teach customers to read prescription labels correctly and work towards building a strong and connected community.
“The engagement can connect members of the community so they can help one another, particularly reminding them to take antibiotics on time. That’s crucial in the medicine’s effectiveness and prevention of antibiotic resistance,” she said.
Empowering school students to use antibiotics sensibly
Asst. Prof. Niyada Kiatying-Angsulee, manager of the Thai Drug Watch, said the network has worked closely with ThaiHealth to empower students in the correct use of antibiotics and foster habits that help prevent the spread of bacterial resistance as part of the “AMR Smart School” programme.
“This collaborative project has been carried out in 78 schools across six provinces; Amnat Charoen, Roi Et, Maha Sarakham, Chiang Mai, Phayao and Rayong.
“We must use antibiotics correctly, so we can get the best treatment when we’re sick. It can also reduce the risks of AMR and protect from side effects caused by unnecessary antibiotic use. It’s very important to educate the next generation about AMR. Teaching them about this issue can help ensure they grow up to understand the importance of using antibiotics responsibly,” she said.
The findings of a survey highlight the need to improve students’ health literacy, antibiotic usage and AMR, she noted, adding that 52% said they didn’t know they had the right to receive medical care and health services. Nearly half of the surveyed students reported limited knowledge on AMR. The most common misconception among them is that antibiotics can treat the flu or common cold symptoms that are caused by viruses.
“Antibiotics won’t make you feel better if you have a virus. And if you take the drugs when you don’t need them, their side effects can cause harm. When you’re sick, it’s always better to talk to a health professional,” the academic said.
The findings also showed that students often receive medicine from their classmates or use leftover antibiotics to treat themselves when they get sick rather than go to a health centre.
“It’s not okay to share antibiotics with others or save them for a different illness. It can cause side effects, wrong treatment and even bacterial resistance,” she said.
Niyada advises taking antibiotics exactly as prescribed and stresses the need to finish the course of antibiotics, saying taking the wrong medicine for future illness may delay correct treatment and can cause severe side effects.
“Don’t save them for later,” she stressed.
Under the AMR Smart School, an AMR curriculum and a range of educational tools and materials were created to educate students about the proper use of antibiotics and the dangers of antibiotic resistance. Games and interactive activities have also been especially designed for them to explain the concept of AMR and make learning fun and engaging.
In Phayao, an online AMR curriculum training session was recently organised for teachers. Creative projects that included media production training as well as poster and art contest were also arranged to encourage students to create posters or artwork that convey messages about AMR and responsible use.
“We equip them with the knowledge and help to build critical thinking skills, so they are able to make informed decisions and use antibiotics properly – not self-medicate with antibiotics and never share them with others,” she said, stressing that antibiotics must only be taken when truly necessary.
Analysis showed that post-test scores are higher than pre-test scores, suggesting that students have a better understanding of antibiotic use.
On top of that, students become aware that taking antibiotics is a shared responsibility. A collaborative effort is needed to ensure their appropriate use, Niyada noted.
More work needs to be done, however, to promote awareness and understanding as to why it’s important to control bacterial infections responsibly among the public.
The academic urged using visual aids and simple language to convey messages to ensure thorough understanding.
“Medical cartoons and explainer videos would be great. The approaches can make health education and tough topics like medication more engaging, understandable and fun, she said.
Niyada urges community leaders and community health volunteers to step up their efforts to help their community, saying interpersonal communication is vital in raising awareness about the importance of proper use of antibiotics and tackling AMR.
“The locals often talk to someone who is close to them about their health and seek advice from acquaintances, the community leaders and health volunteers. They are essential in spreading knowledge and combating AMR issues.” she said.
