ORIGINAL ARTICLE ISRA MEDICAL JOURNAL | Volume 9 - Issue 2 | Mar - Apr 2017

Evaluation of the Irrational Use of Antibiotic and Correlation

of Economical Constraints to Antibiotic Resistance
Altaf Ali Mangi1, Muhammad Ali Ghoto2, Abdullah Dayo3, Ayaz Ali4, Naheed Memon5 , Awais Ahmed
Juno6, Fouzia Panhwar7, Abdul Aziz babar8 , Khalida Unar9, Ghulam Nabi Tatri1

ABSTRACT

OBJECTIVE: To evaluate the irrational use of antibiotic and correlation of economical constraints to antibiotic resistance.
STUDY DESIGN: A Cross sectional Study
PLACE AND DURATION: Private clinics of different districts of Baluchistan from 2nd October 2016 to 30th December 2016.
METHODOLOGY: Patients who showed antibiotic resistance and were belonging to the poor economical background and they were
selected using WHO criteria of poverty which is [low pay under U.S.$2] Well structured Questionnaire was administered to about 500
poor patients and their blood isolates were also collected out of that 400 blood isolates showed resistant when examined in labs only
their filled questionnaire an prescriptions were included that was 80% of total samples.
RESULTS: From 400 participants the number of male subjects was (60%) and the number of female patients was (40%) they showed
antibiotic resistance such as16% males showed resistance to penicillin and 15.26% females, to cephalosporin40.4% males and 38.75%
females showed resistance, 7.9% males and 6.8% females showed resistance to macrolides and besides this 5.4% male and 11.8%
females showed resistance to different other classes of antibiotics.
CONCLUSION: It was concluded that patients due to economical hardships were unable to continue the required time period of
therapy and were quitting the therapy in half and irrational way and that was one of the factor caused the antibiotic resistance.
KEYWORDS: Socioeconomic status, Antimicrobial, Resistance, improper duration treatment.

HOW TO CITE THIS:

Mangi AA, Ghoto MA, Dayo A, Ali A, Memon W, Juno WA, et al. Evaluation of the irrational use of Antibiotic and Correlation of
Economical Constraints to Antibiotic Resistance. Isra Med J. 2017;9(2):106-110
This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License
(http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the
original work is properly cited.
1. M.Phil scholar INTRODUCTION
2. Associate Professor and Chairman Pharmacy Practice Department
3. Meritorious Professor and Dean
As per the WHO Poverty is frequently characterized in supreme
Department of Pharmaceutics
Faculty of Pharmacy University of Sindh Jamshoro terms of low pay – under US$2 a day for instance. In any case,
4. Lecturer truly, the outcomes of destitution exist on a relative scale.1 The
Department of Pharmacy poorest of poor people, far and wide, have the most exceedingly
Shaheed Mohtarma Benazeer Bhuto Medical University, awful wellbeing in Pakistan the aggregate populace is (182.1
Larkana, Sindh, Pakistan million (2013) out of that 40 % individuals are living underneath
5. Professor and Principal destitution line what's more this the lack of healthy sustenance
Pharmacy College LUMHS University Jamshoro
is third most noticeably awful in Pakistan.1-2 Poverty ratio in
6. M.Phil Scholar
Department of Pharmacy, Pakistan is increasing day by day a higher than 40% of the
COMSATS Institute of Information Technology. general population of Pakistan lives under the poverty line and
Abbottabad, KPK, Pakistan their daily income is under 125Rs2.
7. Assistant Professor of Pharmacology, The total population of Baluchistan is about 13.16 million and
Faculty of Pharmacy University of Sindh Jamshoro there are about 52% of the total population lives below the
8. M.Phil Scholar Zoology Department University of Sindh poverty line .There are also 1.1million geriatrics patients having
9. Lecturer
age (65and over) 77% of that is living in the poverty whereas
Department of Microbiology
Shah Abdul Latif University Khairpur, Sindh, Pakistan the numerous others experience the low budgeting &hence
improper prescription follow up3.For such kind of populace the
Correspondence to: expenses of medicines makes it very tough to continue and thus
Altaf Ali Mangi they face the unsponsiveness of antibiotic .It was also observed
M.Phil Student Department of Pharmaceutics that many geriatric patients and less earning Patients got
Faculty of Pharmacy University of Sindh Jamshoro,
antibiotic from different other countries and some could not
Jamshoro, Sindh, Pakistan
Email: altafa41@yahoo.com complete antibiotic therapy that leaded to unresponsiveness of
antibiotics 4-5 Moreover irrational use and consumption also
Received for Publication: 17-01-17 caused its resistance6. Misfortunately those kinds of wrong
Accepted for Publication: 03-05-17 exercises were found to be more prevalent in different districts

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Altaf Ali Mangi et al.
of Baluchistan7-8 In the study it was found that large number of
urban population regarding antibiotic usage for upper
respiratory tract, they got 35% of antibiotic from the source
which were neither registered nor from any qualified
practitioner. And drug inspectors mentioned that the number of
the antibiotics were being sold out over the counter.9 In the
study of emergency Room Patients 23% mentioned using
leftover antibiotic for upper respiratory tract indications.10
Numerous from them brought the antibiotic those were easily
available without the prescription.11 Many people who were
using the uncounted medicines by the help of phone order, it
also added to antibiotic deadens by the usage of suboptimal
standard of the medicine. In the era of 1992 to 1994 about 51%
of counterfeit medicines were exposed under the report of
WHO stating the absence of actives 17% and 11% were
containing the lower than the claimed strength of active
ingredients.12 Moreover 70% of the such counterfeiting cases
were unveiled in the developing countries. In 2003 FDA
analyzed 732 shipments came at Baluchistan, from them 88%
were having unregistered drugs from dissimilar countries.
Surveillance Researches across the country exposed the
happening of poly drug unresponsiveness in common infectious
o rga n i s m a re re s e a rc h i n d i c a t e d S . p n e u m o n i a
unresponsiveness to penicillin, ceftriaxone, erythromycin,
clindamycin, tetracycline, and trimethoprim-sulfamethoxazole.
About 22% of such isolates were multi medicines resistant.13-14
The tendency of augmented flouroquinolines resistance was
also watched out. Neisseria gonorrhea showed more resistance
to penicillin and tetracycline and an emerging resistance to
fluoroquinolones. In 2002, Salmonella found to be
unresponsive to amoxicillin/clavulanate, ampicillin, cefoxitin,
ceftiofur, cephalothin, chloramphenicol, streptomycin,
sulfamethoxazole, and tetracycline was found in many of the
districts including Dera bugti. Nausheroferoz, Mastung and
ziarat, many of the antibiotic resistance were happened due to
irrational prescribing by the clinicians majorly by quacks.15
poverty influences downstream factors that could alter
selective pressure for resistance and promote the
dissemination of resistant strains.16
METHODOLOGY
A cross sectional study was carried out in the private clinics of
different 7 districts of Baluchistan (seven districts (Derabugti,
JhalMagsi, Kharan, Mosakhel, Panjgur, Quetta, Ziarat) Pakistan
to assess the antibiotic resistance. The poor patients who were
suffering from the bacterial disease were included in the study
and those patients who were economical sound were not the
part of this study .Total 500 well developed questionnaires were
administered using the prospective sampling technique after
ensuring the consent of the participants who were suffering
ISRA MEDICAL JOURNAL | Volume 9 - Issue 2 | Mar - Apr 2017
from bacterial disease and patients demographic data was also
sought. Information on antibiotic susceptibility determined by
broth micro dilution as per guidelines of National committee for
clinical lab standards (NLCCS).
The clinical microbiology Labs of University of Sindh Jamshoro
and Liaqat University of Medical and Health sciences LUMHS
jamshoro examined the antibiotic resistance of all collected
blood samples (stored in frozen form) by Disk diffusion method
as defined by NCCLS. and Questionnaire with prescription were
assessed of only those patients who showed resistance to
antibiotics The Questionnaire were containing more than 20
questions to assess the economic status as well.
Data collection: Data was collected by using the prospective
technique and after ensuring the economical background of
patients their blood isolates were collected and processed in
the Labs
Microbiological Studies of isolated samples taken from
subjects who showed treatment failure: The resistance of
isolated blood samples from subjects was made confirmed by
determining the antibiotic MICS by means of micro dilution
broth method with Muller Hinton Broth supplemented by3%
lyse horse blood using NCCLS parameters.
Statistical Analysis: The results were analyzed by spss 19
software by employing chi square test
Ethical Approval: Ethical approval was sought from the ethical
committee of university of Sindh Jamshoro and regarding
patients they were told about the study and on showing consent
they were included in the study.
Inclusion criteria: Poor patients suffering from bacterial
disease were included in study Patients suffering from chronic
and acute bacterial caused disease were included study.
Exclusion Criteria: patients who were mentally unsound were
excluded from study
RESULTS
Age of the head of House hold: Table 01 set out information on
the rate of destitution by time of family unit sets out toward few
areas of Baluchistan territory of the Pakistan. A rearranged U-
shape link is experience amdist time of family head and
frequency of neediness for working age gather in whole
territories/areas. It implies as a family unit head gets more
involvement in labor advertise, the likelihood of passing out of
destitution increments. Notwithstanding, destitution levels
tend to increment when a family unit head is seventy years or
above. It in this manner creates the impression that age and
neediness connection go together principally through the
likelihood of being dynamic in work showcase. The modified U-
faces connection remains constant for the greater part of
regions of Pakistan.
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TABLE - I: POVERTY RATIO BY AGE OF HOUSEHOLD (N=400)

Table - I: shows the poverty status of the seven districts which age wise who were living with poverty and this data was sought
were chosen for research actually it shows the head of family from BISP department Benazir income support programmed)

TABLE – II: GENDER DISTRIBUTION OF SAMPLE (N=400)

Total 400 patient samples showed resistance including 60%male and 40%females

TABLE - III: PATIENTS RESISTANT TO DIFFERENT CLASS OF ANTIBIOTICS (N=400)

Table - III: shows the male and female patients resistant to to pencillin, and 40.4%male showed resistance to
different class of antibiotics .Total males were 240 and females cephalosporin and 38.75% females were resistant to
were 160. the samples collected when examined it was cephalosporin and remaining data is shown .
observed that 16 %male and 15.26% females showed resistance

TABLE - IV: POVERTY AS A FACTOR TO IRRATIONAL AND RESISTANCE OF ANTIBIOTIC (N=400)

The total 240 males and 160 females showed resistance and the factors causing irrational use and resistance are depicted in table - IV.

DISCUSSION to acquire medicines from unofficial and unregistered

Examination of the data above demonstrates that neediness
may assume a part in antimicrobial resistance around the
world.21 It facilitate recommends that viable intercession is
impossible in segregation. In view of universal travel, multidrug-
safe life forms in one nation can be all the more effortlessly
scattered to another nation.16-17 The simplicity of acquiring anti-
microbial without a medicine in some creating nations can
prompt to self-prescription, in those creating nations, as well as
in the Pakistan also.18-19 Furthermore, in light of the web, low
quality and fake medications influence the nation of source, as
well as populaces in the Baluchistan. Many patients were seen
distributors and they were finding it cheaper because their
(medicine) quality was compromised. The Pakistan can't
adequately battle antimicrobial resistance inside its fringes on
the off chance that it overlooks the contributing variables from
creating nations, and it can't plan viable intercession on the off
chance that it neglects to think about and perceive the
destitution driven financial and behavioral elements which can
add to unresponsiveness20-21. Many patients admitted that due
to poverty they took only one tablet in 15 days with shigilla apart
from this patients were coming from very distant areas and this
was adding to their expenses so they were very much unlike to
come for follow up visit. Patients due to financial unsoundness

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acquired incomplete regimen and stopped therapy when only
symptoms disappeared before the pathogen got root out. Due
to poverty the unhygienic conditions were seen as one of the
factor in antibiotic resistance in owning to poor sewage disposal
exchange of antibiotic resistant organisms amdist people and
exchange of resistant genes within bacteria so enhancing the
prevalence of resistant strains were promoted. Poverty also
interferes the patients compliance and patient education
because of poverty many patients could not continue their
therapies and were unable to use antibiotics with correct dosing
strength and frequency so again the irrational use was
observed. A research was conducted on Antibiotic use,
resistance development and environmental factors by Krushna
Chandra Sahoo, India 2009 and he found that improper usage of
antibiotic due to economical unsoundness can cause antibiotic
resistance and it was consistent to current study. A J Tamhankar
2015 India conducted study that due to poverty patients are
unable to continue the required duration of therapy and that
causes antibiotic resistance but the current study is inconsistent
to this study that A J Tamhankar included sample from rural only
while the present study included from urban and rural areas.
Margaret B 2007 America conducted the study that was
inconsistent to current study that his sample size was 800 which
was higher to my sample size and the females were only 20%
that was lower to my sample size.
CONCLUSION
It was concluded that patients due to economical hardships
were unable to continue the required time period of therapy
and were quitting the therapy in half and irrational way and
that was one of the factor caused the antibiotic resistance.
RECOMMENDATIONS
An body could contend that antimicrobial deadness as a
worldwide medical problem is very considerably and more
essential than an unnatural weather change in light of the fact
that the impacts are more quick (ie, demise from
contamination) and are happening inside this lifetime. The
government should increase the Health budgets and seminars
should be organized to give awareness to people regarding
medicine use Confine over-the-counter administering of
antimicrobials without a prescription in all nations;
Contribution of authors:
1. Memon N: Conceived Idea
2. Mangi AA: Designed Research Study
3. Junna AA: Literature Search
4. Babar AA: Data Collection
5. Panhwar F: Literature Review
6. Unar AA: Data Interpretation
7. Unar K: Statistical Analysis
8. Ghoto MA: Manuscript Writing
9. Dayo A: Manuscript final reading and approval
10. Tatri GN: Data Collection
ISRA MEDICAL JOURNAL | Volume 9 - Issue 2 | Mar - Apr 2017
Disclaimer: None.
Conflict of Interest: None.
Source of Funding: None.
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