Is it better to take antibiotics than to do nothing?

In his PhD, Roberto Rubem Silva-Brandão studies how and when antibiotics are prescribed by health workers. And how the inadequate prescription and use of these drugs lead to their inefficacy.

Roberto Rubem Silva-Brandão doesn’t act like a scientist only when he analyses data or participates in a scientific discussion. Being a researcher is his lifestyle. Whether reading a newspaper in the morning, walking through the city, or listening to music, his thirst for knowledge is always guiding him through the world. And, in his words, “this is fuel for life” for him. With this investigative and also interdisciplinary mindset, he has, since his Bachelor’s in Nutrition, made connections between different fields to understand the complexities of being a human in society.

After a second Bachelor’s in Social Sciences, today Rubem applies his interests in health and society to his PhD in Public Health at the University of São Paulo (USP). In his study, he investigates how and when antibiotics are prescribed by health workers. And how the inadequate prescription and use of these drugs lead to their inefficacy. He explains: “[I] study how some drugs made to kill bacteria can stop working due to misuse. To understand that, I talk to doctors and other people who work in health care.”

Antibiotics are drugs that destroy bacteria and therefore should only be prescribed and used when we have a bacterial infection. When we take such a drug, the treatment works as a fight between the antibiotic and the bacteria. Antibiotics were developed to win this fight, and this worked for a long time. But back in 1945, the discoverer of penicillin, Alexander Fleming, already warned that the inappropriate use of antibiotics could lead to a big problem: antibacterial resistance. This occurs when bacteria are able to survive treatment with an antibiotic. In this scenario, natural and random changes in the genetic code of bacteria have made them resistant to this drug. As a consequence, such an antibiotic is ineffective against these bacteria and the infected person who takes this drug will remain infected and untreated. Also, there is the risk of this person transmitting it to other people. And the worst thing is that this situation has become more and more common: different types of bacteria have become resistant to different types of antibiotics. In other words, to summarize, the indiscriminate use of antibiotics can lead to infections that are very difficult to treat or even incurable.

Adapated from Center for Disease Control and Prevention

But isn’t it enough to just develop new antibiotics? Unfortunately not. Remember it was mentioned above that there are natural and random changes that occur in the genetic code of bacteria? Well, these changes, the mutations, will continue occurring regardless of whether new antibiotics are developed. So, bacteria will continue to try to dodge antibiotics. But then, what else can be done to decrease this problem?

One solution is the proper use of antibiotics. That is, take the medication only when there is a bacterial infection, which should be diagnosed by a healthcare worker, with the help of laboratory tests. Also, antibiotics shouldn}t be used to prevent an infection. They should only be used when the infection has already started. And finally, one should only take these drugs for a limited time, indicated by the health worker. Although it may sound simple, in practice, the situation can be very complicated. Both for the prescriber and for the patient who needs to take the antibiotic. But why?

That is the question Rubem is investigating in his Ph.D. “[W]e still don’t know everything that influences the wrong use of some medications (both by prescribers and patients), so we can’t solve the problem. This work is very important because no study in Brazil sought to understand the context where antibiotics are prescribed in primary care. All the studies in Brazil occurred in hospitals and outpatient clinics and were very quantitative. In other words, they sought to understand the quantities of drugs prescribed, but didn’t ask about the conditions and problems that influence these prescriptions and the inadequate consumption of these drugs.”

According to the nutritionist, “In primary care, the inadequate prescription of antibiotics may represent up to 70% of the cases of failure of action of antibiotics, which indicates that we are creating incurable “super bacteria” that can lead to death. If we continue at this rate, by 2050 there are expectations that people will die more from antibacterial resistance than from cancer. My study seeks to help understand this problem at the heart of prescriptions so that, at a later stage, we can put in place measures and policies to prevent this catastrophe from happening.”

This is an even bigger problem in the context of the covid-19 pandemic. Despite being caused by a virus, the antibiotic Azithromycin has been recommended by the Brazilian government. Studies show that treatment with this drug doesn’t make any difference in the recovery of patients. Yet the government continues to reinforce its use, along with other ineffective drugs. Besides wasting public money, the use of Azithromycin in this context contributes to the worsening of antibacterial resistance. Thus, concerning the inadequate use of antibiotics, understanding where the problem lies – whether in the prescription, in the use, or both – is essential for more adequate treatment. This is not only better for the patient himself or herself, but also the community at large, as it could prevent the proliferation of “super bacteria”.

To carry out his project, the scientist from São Paulo works with a team of several researchers. “Each one focuses on different parts of the project. For example, I have a colleague who works with the public policies involved to give answers to the problem. Another colleague interviews the patients in their homes in Campo Limpo, in the outskirts of São Paulo. We have daily virtual meetings, with discussion, data analysis, reading of scientific articles, and writing up of the results. All this is done online because our professors are from Brazilian and Danish universities.” The first fruits of this project will be published soon.

Besides his doctoral activities, Rubem also teaches classes and attends some patients as a nutritionist. In his spare time, he enjoys listening to music, reading, walking around the city aimlessly, and travelling. His passion for exploring new experiences has, thus, guided his personal and professional lives: “That is the place of passion, a mix between self and desire, that is, what you like doing is a big part of yourself.”

Thank you so much, Rubem, for sharing your story and your research. May your passion for knowledge continue guiding you in your search for an intense life you deserve and desire.

Follow more about his career here.

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