WHAT IS PRIVATE CLINIC?
Private clinic is the premises where a doctor or general physician or in some countries a surgeon (for minor surgery) or groups of health care providers provides health care facilities or advices to their patients by charging a fee. It is not run by government of state and carried out all its functions independently.
ADVANTAGES OF PRIVATE CLINICS OVER PUBLIC HEALTH CARE FACILITIES
1. Reduction of waiting time (no need to wait in long que).
2. Better relation between health care provider and patient results in good and consistent delivery of patient care services.
3. As clinics are mostly near to house So, it reduces the time required for getting medical care services.
4. Patients can easily protect their privacy in comfortable environment.
DISADVANTAGES OF PRIVATE CLINICS OVER PUBLIC HEALTH CARE FACILITIES
1. Expensive one.
2. Limited resources or health care facilities as compare to hospitals.
PRIVATE CLINICS AND ANTIBIOTC RESISTANCE
As we all know that, private clinics play a great role in delivering health care services in developing countries but the role of these clinics in antibiotic resistance is also great. Antibiotic resistance is a global issue. In developing countries like Pakistan irrational prescribing of antibiotic for invalid duration especially in private clinics has a key role in antibiotic resistance. Here, I will explain AMR,
WHAT IS AMR? (ANTI MICROBIAL RESISTANCE)
Antimicrobial resistance is the condition in which antimicrobial drugs are not working against bacteria, virus and fungus effectively because of resistance development and they become more harder pathogens. Now I will discuss some factors of AMR due to private clinics,
AMR WITH INAPPROPRIATE DOSING AND DURATION
As we know that every corner of street in big cities has at least 2-3clinics. Suppose a patient came to clinic with mild symptoms of diarrhea. The physician prescribed the metronidazole syrup to patient for one day from the clinic pharmacy (clinic pharmacy usually has metronidazole or other antibiotic syrup in bulk) and advice patient to visit clinic tomorrow again. After taking this antibiotic syrup, patient gets relief from diarrhea for 2-3 days. Afterward, patient has same problem and same symptom again and same prescribing and dispensing for one day again. Inappropriate dosing for inappropriate duration results in antibiotic resistance. This antibiotic resistance sometime became fatal because of emergence of CLOSTRIDIUM DIFFICILE ASSOCIATED DIARRHEA.
WHAT IS CLOSTRIDIUM DIFFICLLE INFECTION?
Improper use of antibiotics in high doses for prolong period or inappropriate dosing for inappropriate (taken for less duration than the prescribed duration) period of time will cause alteration in gut microbiota as a result of which clostridium difficile cause inflammation of colon by releasing toxin which may results in mild to severe diarrhea may be accompanied with fever and abdominal pain. It may become sometimes life threatening and may results in death.
CASE HISTORY OF A YOUNG GIRL
As mentioned above dispensing of metronidazole syrup in private clinics can provoke fatal clostridium difficile diarrhea. A young girl of 10 years old has become victimized of this immoral and irrational practices of private clinics in my area.
LESS CONCENTRATION OF ACTIVE INGREDIENTS IN BULK SYRUP AND AMR
Another reason behind the antibiotic resistance is that usually bulk syrups which are present in private clinics have less concentration of active ingredient which ultimately results in less bio-availability and will be definitely less effective against infected organism.
LACK OF PHARMACIST AT CLINICS AND AMR
Usually, at private clinics for dispensing of medicine less educated person or technician are hired to reduces expenses and in order to get maximum revenue. Due to which EDUCATION ABOUT ANTIBIOTIC STEWARDSHIP IN COMMUNITY is out of question. Lack of pharmacist at clinics is also a risk factor for AMR because pharmacist will be in better position by reviewing prescription right from selection of antibiotics till dispensing of antibiotic with proper patient counseling which will definitely improves patients’ outcomes.
WHAT IS ANTIBIOTICS STEWARDSHIP?
Antibiotics Stewardship is the process or programmed which compelling the health care provider for proper selection of antibiotics when it necessary and for appropriate period of time with appropriate dosing in order to avoid AMR in pathogens.
IRRATIONAL ANTIBIOTICS PRESCRIBING FOR PATIENTS SATISFACTION AND AMR
Physician at private clinics, usually do not run test for diagnosis and antibiotic prescription because it increases cost of treatment. They usually do not bother about type of infection whether it is viral or bacterial. In viral infection, there is no need of prescribing antibiotics. Only symptomatic treatment is required and after 4-5 days infection will be subsided. Only for patient satisfaction antibiotic are prescribed irrationally which is the major factor in the emergence of antibiotic resistance.
OVER USE OF ANTIBIOTICS AND AMR
If patient is not getting well then visit to another clinic may switch the patients to more potent antibiotics which become strong factor of AMR.
COMMISSION FROM PHARMACEUTICAL COMPANIES AND AMR
Pharmaceutical companies give commission to physician to prescribe their company brand which will ultimately lead to antibiotic resistance due to irrationally prescribing of broad-spectrum.
HOW CAN WE OVERCOME THE PROBLEM?
Join hand together right from very beginning till end which means from prescribing, dispensing till education. Dispensing of antibiotic from bulk should be stop immediately at clinics. There must be some vibrant government body which enforce antibiotic guidelines practices in private clinics. There must be pharmacist at clinics who will be able to educate the community about proper dose, frequency and time duration of antibiotic and about the consequences of irrational usage of antibiotic. Broad spectrum antibiotic should not be prescribed for commission purpose. Differential diagnosis between viral or bacterial infection should be carefully taken in to consideration. Encourage vaccination which will prove to be very effective in reducing AMR and will protect the patients from the irrational antibiotics prescribing. As a result of it, the gut microbiota or gut flora (microorganisms which are present in gut) will not be disturb and the patients will be protected from antibiotics associated health Consequences.
CONCLUSION
Own the antibiotics Stewardship to protect the future generations lives from resistant microorganisms.