Treating antibiotic-resistant infections among children in Uzbekistan

Dr Nigora Tadjieva works for the Research Institute of Epidemiology, Microbiology and Infectious Disease in Tashkent, Uzbekistan. She has 20 years of experience, the last five of them as head of the department for acute intestinal infections in children under the age of one. Each year she treats approximately four infections that are resistant to antibiotics, primarily those caused by Salmonella and less frequently Shigella.

What have you experienced when treating patients with antibiotic-resistant infections? How does the treatment differ from that of patients who respond normally to antibiotics?

If a resistant strain of Salmonella causes disease, then the course is severe. Empirically administered antibiotics do not work or make any form of improvement. So then we have to switch to reserve antibiotics. This lengthens the duration of treatment. There is twice as much treatment so there is also a higher cost and greater use of resources. For both the children and their parents, these longer treatment times and longer waits for lab tests have a negative effect, compared to normal cases.

How do parents generally react when you tell them that you cannot prescribe antibiotics and that you need to wait for the lab to confirm the pathogens causing the illness?

Quite often parents want antibiotics prescribed before we have lab confirmation; they are overly eager to start antibiotics. We try to explain to parents the dangers of improper prescription and administration of antibiotics, and that this kind of use of antibiotics may influence other organisms in the body. It is better to use antibiotics that would have a direct impact on the agent causing the disease. I also explain that we are dealing with very young children and antibiotics can have a severe effect on them. Parents usually agree with my recommendations in the end because they want to help their child get back to normal quickly.

Do you find that you have to educate your peers – fellow health care workers – about the dangers of antibiotic resistance?

Sometimes I do have to educate my peers, and not all of them are receptive. Some may resist the information, so we provide them with guidelines on how to prescribe and administer antibiotics properly. We try to convince them to follow the guidelines.

Do you have any advice for other health care workers about how they can help stop antibiotic resistance?

My advice to health care workers is not to rush into prescribing antibiotics. I would like to see more awareness raising and training activities on antibiotic resistance, both through the mass media for the general public and also specifically for health care workers, so they know exactly what they are doing with antibiotics.