Despite guidelines on antimicrobial resistance, younger patients continue to request unnecessary antibiotics.
SINGAPORE: A recent study has revealed that over a four-year period, approximately 12% of oral antibiotics prescribed in polyclinics were given without any diagnosis of infection. This comes despite established guidelines warning that improper use of antibiotics can contribute to the growing issue of antimicrobial resistance.
The study, conducted by National University Polyclinics (NUP), examined more than 3.2 million consultations across seven polyclinics from 2018 to 2021. The aim of the research is to help combat antimicrobial resistance within primary care and support the development of local antibiotic guidelines and policies.
Younger Patients Seeking Antibiotics
The study found that younger patients, particularly those aged 21 to 44, often have a poor understanding of antibiotic use. Many of these patients show a “demand and expectation” for antibiotic prescriptions, which has also been observed by private general practitioners.
“We have patients who are pushy, requesting antibiotics, pressuring us for antibiotics,” said Dr. Chua Guan Kiat, director of Chua Medical Clinic & Surgery. “At times they are impatient because they need a quick fix, but that’s really the wrong approach.”
Dr. Chua noted that younger patients often lack knowledge about the differences between viral and bacterial infections. Antibiotics are ineffective against viral infections, which are the most common cause of conditions like the flu.
Dr. Lim Kim Show, director of Life Family Clinic, explained: “If a patient has mild symptoms for one or two days, it’s usually a viral infection. We would prescribe symptomatic treatment. Antibiotics won’t help.”
Serious Consequences of Misuse
Antimicrobial resistance occurs when bacteria evolve and become resistant to the drugs designed to kill them, including antibiotics. This makes infections harder to treat and could result in longer, more severe illnesses.
“For a patient whose bacteria has developed resistance, their symptoms—like fever, cough, and flu—will persist even after taking antibiotics,” said Dr. Lim.
The Ministry of Health (MOH) has warned that the excessive and inappropriate use of antibiotics exacerbates resistance. Overuse leads to the need for stronger, more expensive drugs, which may come with more side effects and require longer treatment durations.
Doctors also noted that misuse can have broader implications, leading to increased resistance within the community. “The whole community ends up using stronger options, making the situation worse. A lot of patient education is needed,” said Dr. Chua.
Doctors Urge Proper Antibiotic Use
To mitigate resistance, doctors encourage patients to complete the entire course of prescribed antibiotics and avoid saving them for future use. “Completing the full course ensures the infection is fully cleared, leaving no bacteria behind,” Dr. Lim emphasized.
Education and clear communication are essential to ensuring antibiotics are prescribed and used appropriately. “Doctors should explain the rationale behind prescribing—or not prescribing—antibiotics, based on evidence and guidelines,” Dr. Chua said.
Dr. Sky Koh, the lead author of the NUP study, added that clinicians should accurately document diagnoses and prescriptions to ensure the proper use of antibiotics. “Each prescription must be directed at a clear diagnosis and in accordance with guidelines,” he explained.
Dr. Koh also noted that with no new antibiotics introduced in the past 30 years and guidelines unchanged since 2006, there are significant gaps that need to be addressed. NUP is working on developing its own guidelines for antibiotic prescriptions, considering local resistance patterns and international standards.
