CUSCO, PERU — An elderly woman wearing five sweaters shuffled through her purse to find the pills she had been taking. She pulled out a small sheet of four pills and another sheet of two pills.
This woman, like many patients at the clinic, had used antibiotics to cure her common cold, taking two pills here and three pills there as soon as her throat started to hurt. After one or two days, she’d be cured and would stop taking the pills.
In the United States, federal law states that the purchase of all antibiotics requires a doctor’s prescription. Why? Antibiotics specifically treat illnesses caused by bacteria and only health professionals can truly tell whether symptoms are caused by bacteria or not.
If you take the wrong antibiotic, your symptoms won’t get better. If you take an antibiotic when you don’t need to or don’t finish the complete treatment course (typically 7–14 days of pills), you risk developing antibiotic resistance.
As the antibiotic tries to kill the bacteria in your system, the bacteria turn on their survival instincts. After spending time with the antibiotic, they adapt and learn how to get around it, becoming immune to it. This is the same reason we’re supposed to change up our skincare products every now and then — our bodies adapt and get used to the chemicals we introduce to them. Once the bacteria has adjusted, it becomes a strain or version that can’t be treated with that particular antibiotic. If this resistant version affects you or anyone else again, doctors will have a hard time prescribing something that will actually work.
Something as simple as strep throat would become deadly. So deadly that we’d call it a superbug.
So, imagine my shock when this woman, among other patients, pulls out her antibiotics and explains that she’s only taken a handful of the pills to kill her sore throat.
In Peru, and many other Latin American countries, antibiotics can easily be purchased over-the-counter or without a prescription. In almost every corner store or botica (pharmacy), you’ll see ampicillin, penicillin, and many other antibiotics. All you have to do is walk up to the store clerk and say you have a headache for them to rip off a section of three or four antibiotic pills for you to buy. Even if it’s the wrong antibiotic or a fraction of the complete treatment course, your common cold will slow down over the next few days and you’ll decide that the pills worked. Plus, they were cheap and you avoided a trip to the doctor’s office.
For that reason, this short-term solution of self-medication appeals to the majority of underserved patients who lack insurance or can’t miss a single day of work.
I’d say the solution is stricter regulation, but because the populations have already gotten used to the ease of buying and selling antibiotics, it would be difficult to enforce new rules. For the patients of course, but even for the botica owners and employees who see selling antibiotics as another way to make quick money. In places like Peru, corruption affects almost all aspects of life, including healthcare. When you have black market hubs of adulterated and expired medicine, keeping the teenager at the corner store from selling three pills to an elderly woman is both low on the priority list and hard to expect actual change from.
In all honesty, there are more similarities between the US and Peru than we think. A recent study in the Annals of Internal Medicine states that self-medication of antibiotics is causing a drug resistance problem, much like the one in Peru, in the United States.
For the same reasons too. The study blamed poor access to health-care, the hassle and cost of the doctor’s office, the cost of a full treatment course of antibiotics, and even embarrassment of getting treated for bacterial STIs.
What’s more interesting is where the antibiotics came from: places like flea markets, friends and family, and community swap meets. Again, something very hard to address through rules and regulations.
So, it’s near impossible to address this problem top-down or systematically. In Cusco, what I’ve seen work is education.
Every time a patient came into the consultation with antibiotics they shouldn’t have taken, the doctor took the time to explain to them how the antibiotics worked and the dangers of their misuse. By the time the doctor was done, the patient would be terrified of the concept of superbugs. The goal of instilling this understanding and fear was to prevent them from unnecessarily buying antibiotics again.
I say this works because whenever I would bring up the ease of obtaining antibiotics in conversation with my host family or local friends, they would explain antibiotic resistance to me and tell me how big of a problem it was.
While my host family and friends weren’t in the socioeconomic bracket that would lean towards self-medicating in the first place, this meant that something a doctor once told them actually stuck. That’s some kind of progress, right? Rather than blindly and hopelessly enforcing rules that don’t appeal to struggling demographics, it’s better to educate communities, be it in a classroom or a consultation, so that individuals will choose not to self-medicate with antibiotics and understand why.