The World Health Organization says antibiotic resistance is one of the leading public health threats on the planet. A six-month investigation by The Associated Press found overuse and misuse of medicines has led to mutations in once curable diseases like tuberculosis and malaria, making them harder and in some cases impossible to treat.
Antibiotic use in most western countries is widespread. Antibiotics are given as first line of treatment for just about anything you like to mention. In maternity care, antibiotics are poured into pregnant women who test positive for Group B Streptococcus on vaginal swabs and those pregnant and labouring women whose 'waters' (membranes) have been 'broken' for longer than 18 hours. Antibiotics are used as a cure all, even when there is nothing that can be cured by them, even though antibiotic resistence is rising and even though antibiotic use is associated with long term problems for the infant.
However, Norway has taken a radical approach to antibiotic use. Norweigans have stopped pushing antibiotics. Methicillin-resistant Staphylococcus aureus (MRSA), a virulent killer in most hospitals in the west, has been controlled in Norway because Norweigans take less antibiotics.
"Penicillin is not a cough medicine," says the tissue packet on the desk of Norway's MRSA control director, Dr. Petter Elstrom.
"Norwegians are sanguine about their coughs and colds, toughing it out through low-grade infections. "We don't throw antibiotics at every person with a fever. We tell them to hang on, wait and see, and we give them a Tylenol to feel better," says Dr John Birger Haug, the infectious disease specialist. And because Norwegian doctors prescribe fewer antibiotics than any other country, people do not have a chance to develop resistance to them.
According to a press release on December 31 st 2009 by Associated Press Writers, MARTHA MENDOZA and MARGIE MASON, Aker University Hospital's pharmacy does not stock the newest, most expensive antibiotics, because as Dr Haug says "because if we have them here, doctors will use them."
I've noticed that doctors, at least in places I've worked, are frightened not to prescribe antibiotics for fear of being sued if 'something goes wrong'. Fear of litigation is a huge issue in our country and common sense goes out the window when this fear is activated. The mantra in mainstream medicine, at least, for those involved with the care of birthing women is the more you do, the safer you are, however, the safety factor is about being protected from litigation NOT what is best for the woman and her baby.
Group B streptococcus (GBS) management is a perfect example of how fear of litigation overtakes common sense. In Norway, women who test postitive for GBS in pregnancy are offered a Chlorhexidine solution vaginal douche in early labour and every six hours to minimise the potential risk of GBS transmission to the fetus/newborn. The use of this douche is dismissed as unscientific in Australia because doctors prefer the 'security' associated with IV administration of antibiotics.
Thank goodness some doctors and health services are more open minded. At John Hunter Hospital, Newcastle, NSW, where routine screening of all pregnant women at 34-36 weeks for GBS colonisation is recommended, while women are advised that antibiotics in labour are the preferred option, they are informed about Chlorhexidine douche. The policy of providing chlorhexidine douche as an option for GBS prophylaxis came about following the visit of a Norweigan Obstetrician who explained their successful approach to GBS management.
When women are given the information about GBS colonisation and risks of infection and a choice of having an IV cannula in their arm and IV antibioitics or a self administered vaginal douche as a prophylaxis for GBS infection, the overwhelming majority of women choose the douche.
Despite the misgivings of the paediatric and some obstetric staff, no baby whose mother has used Chlorhexidine vaginal douche for GBS prophylaxis has been infected with GBS in four years.
Chlorhexidine vaginal douche as prophylaxis for GBS colonisiation is a cheap, easy, benign and effective solution (no pun intended) to the rampant use of antibiotics, and all the long term iatrogenic sequelae, in pregnant and labouring women. The use of a chlorhexidine douche for this common condition will not only be safer for babies long term health, it will help contain antibiotic resistence, ensuring that antibiotics will be effective if ever a person truly needed them.
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