Antibiotic overuse: a silent danger threatening public health and medical practice in Iraqi Kurdistan

 By Rawaz Sulaiman: 

Antibiotics or antimicrobials are medications used to treat diseases caused by infectious agents such as bacteria and fungi, either through slowing down their growth or destroying them. Viruses, in contrast, do not respond to antibiotics at all. Selecting a proper and relevant antibiotic, for example, can be made through detection of pathogens in the lab and antibiotic sensitivity test. The latter is done to help choose the most effective antibiotic against related pathogens and to avoid using a wrong or improper antibiotic.

From the clinical practice point of view, antibiotics have been used enormously for curing diseases. This happens in most, if not all, houses in a form of self-use. A number of factors contribute to this. First of all, there is the style of medical practice, which is mostly old fashioned. Private clinics, for instance, usually open from afternoon until evening and, in that period, physicians normally see as many patients as possible. In such instances, diagnoses are made based on direct information from patients, clinical signs and quick laboratory tests to get some evidence. Predominantly, prescribing strong antibiotics covering most of the expected pathogens is usually preferred, not only to save time but also for physicians to get a good reputation and become famous among people for curing diseases, regardless of adverse or side-effects.

Additionally, there is the lack of a strict policy for physicians and people related to antibiotic usage. Most often, people use antibiotics as a form of self-treatment, clueless of what the infectious causes are. Often, this results in side-effects. It is generally recommended to read or learn antibiotic indications prior to use. Many people do, but they are still amazed, maybe even angry, if they leave the doctor’s office empty-handed because they want something to make recover them soon.  All of these points and a lot more have created a good pitch for pharmaceutical companies to develop their businesses.

What is important here is that the improper taking of antibiotics not only won’t work, but it also has a dangerous effect: over time, these aids create stronger bacteria that will become much harder to kill, i.e. it is likely that consistent and inappropriate use of antibiotics will result in bacteria or other microbes that can resist the action of antibiotics. This phenomenon is known as bacterial resistance or antibiotic resistance. You may be wondering now how this resistance occurs? Obviously, bacteria can become resistant via several ways, such as genetic mutation and gaining resistance from other bacteria. Genetic mutation is the modification of bacteria’s genetic material. Some mutation, for example, allows bacteria to inactivate antibiotics through producing potent enzymes. Overcoming these resistant bacteria requires much robust antibiotics or higher doses of medicine. Eventually, nowadays, certain types of bacteria have gained resistance to even the most potent antibiotics available today.

What has been said above may be unclear; let’s take an example for more explanation. MRSA skin infections have been in the news currently because the bacteria that cause them are resistant to the antibiotics used to fight most staph infections. MRSA stands for methicillin-resistant Staphylococcus aureus, a type of staph bacteria. Many strains of staph bacteria are popular, and most of us have staph living harmlessly in places like the nose or skin. Normally, staph bacteria can enter the body through an open wound or rash and this leads to minor skin infections. In most cases, the infection heals spontaneously if the wound is kept clean and bandaged, but sometimes antibiotics are required.

What makes the MRSA unique from other staph bacteria is its resistance to the antibiotics that routinely treat staph infections. (Methicillin is an antibiotic, which is why the strain is called “methicillin-resistant”).

Although MRSA is in the news today, it is not a new infection; the first reported case dates back to 1968. During that era, people with weakened immune systems such as those staying in hospital wards were mostly at risk. Unlike that time, nowadays, other considered healthy people are also susceptible to getting MRSA. This is dubbed Community-Associated MRSA (CA-MRSA), and it’s largely due to antibiotic resistance. Additionally, people can also be “carriers” (meaning that they retain the bacteria for a long period of time in places like the nose, respiratory tract and urinary tract. Hence, they are able to transfer it to others).

All this mean that it’s difficult to treat MRSA like other infections. In 2012, 292 deaths were reported in the UK due to MRSA. In 2005, the US Center of Disease Control reported that more than 18,000 deaths were attributable to MRSA, which kills more Americans than AIDS does.

If we take MRSA as an example, it will be clear now that, with the current status of healthcare and medical practice in the region, such a microbe and many more can emerge or may have been present for a long time. Owing to the lack of proper data in our region, we don’t actually know: where are we now? Could there be present other disease agents, rather than MRSA, that none of us are aware of?  If the current situation continues, it is highly possible there will be calls for more international pharmaceutical companies to develop more powerful medications. If that happens, changes will be for the worse not better.


Rawaz Sulaiman has an MSc. in Biomedical sciences from Sheffield Hallam University, UK

5 Responses to Antibiotic overuse: a silent danger threatening public health and medical practice in Iraqi Kurdistan
  1. Hawar Moradi
    February 23, 2014 | 16:46

    a very well written article about a very important subject. I was really frightened by the amount of drugs and especially antibiotics that could be bought without a Doctor prescription or even information for how some one should use it.unfortunately this problem is not only in southern kurdistan but in other countries in middle east as well. To deal with such a problem definitely requires a huge support from the KRG but also from the patients as well.During a two week voluntarily practice i did in the city of Kuye, i was shocked how people saw a normal x-ray as a treatment rather than a diagnostic approach. I as a medical doctor definitely see this problem growing and its definitely a significant threat to the health of southern kurdistan population.There are many ways which we deal with decreasing the amount of antibiotics prescribed both in sweden and Norway where i have worked, and i am sure it could be done even in southern kurdistan. With a will and enough resources everything is possible.To the author of the article, i would want to declare my service as a medical doctor if there is anything we can do in this field.please let me know.

    • Rawaz Sulaiman
      February 25, 2014 | 08:18

      Thanks a lot dear Hawar for showing your support :), in fact, what you really said was one of my main aims in writing this article. We can get benefit from your experience abroad. Surely I’ll be in touch with you, this is my mail (

  2. Azhy Hamakhan
    February 27, 2014 | 07:39

    Very nice articel. Dast xosh

  3. Heshu
    February 27, 2014 | 09:40

    Great Job and well done

  4. Rawaz Sulaiman
    March 3, 2014 | 13:10

    Thanks a lot dear Azhy and Heshu 🙂

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