The Over Prescription of Antibiotics in Thailand

Antibiotics over prescribed in Thailand

Antibiotics Over Prescribed?

Up until I was age ten or so I was at the doctors office every other week with some sickness or because some dumb-ass stunt backfired again and I required stitches. The doctor always patched me up fast and just about every visit included a lollipop ( grape, my favorite ) and a shot of penicillin whether it was needed or not, the penicillin…of course I needed the lollipop!

Those days soon faded away as each new visit to the doctor or hospital saw a rapid decline in the use of penicillin and lollipops, I understood why the penicillin all but stopped but the ” You’re too old for lollipops thing” still irks me. Cherish it while you can kids.

The advent of antibiotics was a revolutionary step in the treatment of infectious diseases, doctors thought they had found the God drug, the miracle bullet and made sure to use it as often as possible, even for minor illnesses that really didn’t necessitate antibiotic use, just to be on the safe side. But, what could it hurt? We know now that the opposite is true.

The Antibiotic curve over the years

The Antibiotics Curve over the years

Basically, when we take antibiotics that aren’t needed there are no unhealthy bacteria for them to fight so, the antibiotics go after the healthy bacteria in our bodies. The healthy bacteria then goes on the attack as it sees the antibiotic as an intruder. As the Healthy bacteria battles the antibiotic it finds ways to overcome the antibiotics charms leaving our bodies much more resistant to the drugs over time.

Penicillin was so overused in the States that, I chide you not, the doctor would sometimes give us a double shot of penicillin if we were coughing too much…bastard never gave me two lollipops though.

While the penicillin slowed to a trickle in the seventies we were still given new and hybrid antibiotics such as amoxocillin or something similar that usually did the job, but it took a little longer and sometimes another antibiotic would have to be used in unison to get the same effect. The theory here was that mixing up the antibiotics would leave our bodies less resistant to the drugs. Unfortunately antibiotics were still over prescribed. By some accounts antibiotics are still over prescribed today in the West  by a staggering 40%

If antibiotics are still over prescribed in the West by 40% then there can be no doubt that Antibiotics in Thailand are over prescribed by at least 100%. and most likely more.

Throughout my trips to Thailand, and now that I am living here I have partaken of the Thai medical system here quite liberally, much more than I would like in fact and Antibiotics are a way of life here.

Thailand is much like the West was in the 1970′s. Where we had family doctors to tend to our everyday illnesses in the states, Thailand has clinics, and lots of them. These clinics serve as the family doctor for all minor ailments and if you are smart, once you find a good clinic, you frequent that clinic and build up a rapport with the doctor. Then when the need arises you know that you are being seen by someone that knows your history well. I have been going to the same clinic and doctor in Thailand for over 5 years now.

Unfortunately, the doctors in Thailand never seemed to have gotten the memo on antibiotics, as a matter of fact I think they take their cues from my old childhood doctor who had no problem loading me up with antibiotics, and no, they still don’t give me lollipops, the bastards!

Seriously though, this presents a problem not only for me who is susceptible to many minor ailments such as tonsillitis, conjunctivitis, and most importantly dumb-assitis which struck recently at a local water park. This is a major problem for the Thai population as a whole, especially the children.

Old antibiotic promotional posterYou see, many Thai doctors believe in the two pronged approach to curing what ails you. Such was the case this week when I found out I had conjunctivitis. I went to the clinic and the doctor confirmed my fear but this time he was slightly conservative in his approach. Instead of a shot of penicillin and multiple antibiotics he prescribed antibiotic eye drops and 2 different antibiotics in small doses for 3 days.

3 days later my left eye was still pink and swollen so I headed back to the clinic and the this time the nuclear approach was taken. I was given 2 shots of penicillin, cheek to cheek, and 3 prescriptions of different antibiotics to be taken 2 at a time three times a day. That’s 18 pills a day!

Now, as an educated adult I should know better as to why this is not good for me, especially since I am susceptible to tonsillitis, strep throat and conjunctivitis as it is. I didn’t speak up because I knew this would cure me quickly, it always does. As a matter of fact just the two doses of penicillin would be enough to do the trick.

Since I go to the same clinic and doctor the vast majority of time he tends to mix up the doses and antibiotics given to me, he still over prescribes in my estimation but I acquiesce because I’m a sissy and hate being sick. I’m usually right as rain within a few days whereas the same problem in the states I had some time ago with strep throat landed me in the hospital with a severe case of strep because the American doctors didn’t act aggressively enough in treating it.

On one hand I enjoy being able to have the nuclear option or just penicillin when I think I need it ( every few months lately ). I know what works for me and at 45 my body has seen enough antibiotics that I think I’ll be okay with resistance. Many of us think like this and sadly it’s the wrong way to think, more so it’s selfish and could be deadly.

When antibiotics are over prescribed on this level it’s not so much you that will be hurt but the repercussions to the community around you. Children and the old are the most susceptible to bacteria and viruses. Routinely over prescribing antibiotics to  these two groups has a host of negative effects from allergic reactions to death in some cases. In children the over prescription of antibiotics has the worst effect. We are basically raising an antibiotic resistant generation.

All children get sick often it’s just a fact of their immune systems growing and developing. It seems to me though that Thai children get sick much more often and are much more prone to life threatening diseases,bacteria and viruses. The Thai children in rural Issan even more so. The children I have seen and have known seem to have a much higher incidence of cold, coughs and flu and I’ve seen quite a few children that have had had prolonged cases of infections including some very bad flesh eating bacteria.

In some of these cases the only and last resort is heavy duty IV antibiotics that run rampant through the body killing any bacteria in it’s way. This has been readily apparent in rural Thailand on the border with Cambodia where drug resistant Malaria is once again rearing it’s ugly head. A disease that was once all but defeated has adapted to become very resilient to the the normal routine of antibiotics usually given. While steps are being taken and a new antibiotic regimen is being used successfully in these new resistant malaria cases how long will it be before it becomes more commonplace and how many people will die.

There is a real fear here that once defeated diseases that were all but forgotten will once again become commonplace in the world. Already new strains of tuberculosis can be found in almost every country in the world and measles are once again on the rise. Will it take place again in our lifetime that measles or another affliction like it will once again becomes an epidemic killing millions? Many doctors are placing blame on parents not getting their children vaccinated in the case of measles but a growing contingent of doctors are quietly pointing to their own complacency as the real culprit because they haven’t kept up promotional programs informing the public.

antibiotic warning bookletThese same promotional programs have been lax in the field of antibiotics and its high time this was rectified.

Just to be clear, antibiotics can only cure bacterial infections they have no effect whatsoever on viruses and I was only using viruses in my previous statement to show that many of the once thought dead and gone afflictions humans have suffered have started coming back with a vengeance.

Thailand is a relatively small country in the grand scheme of things but if the over prescription of antibiotics continues it can and will have a large impact on the world. And if American doctors are reportedly still over prescribing antibiotics by as much as 40% you only need to ask yourself how many more countries like America and Thailand are doing just the same.


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13 Responses to The Over Prescription of Antibiotics in Thailand
  1. Martyn
    February 18, 2011 | 4:53 pm

    Good post Talen. I tend to overuse antibiotics, especially when I’m in Thailand. I always get a bad chest due to over smoking and air con in hotels. When my spit hits the pavement and colours it green I tend to head to the pharmacy rather than a doctor. Amoxocillin works for me every time, it shouldn’t because I’ve taken so many in the past, but it does the job after taking a five day course.

    I think most doctors hand out prescriptions for antibiotics because they generally keep the patient happy. Having faith in the pills you’re taking goes a long way to winning the fight. However overuse as you point out does have its knock on effect.
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    • Talen
      February 18, 2011 | 5:18 pm

      Martyn, It is a tough call at times. I’m glad I got the nuclear antibiotic treatment yesterday as today I feel 100 times better. I don’t think I have much of a problem with resistance but obviously the world does and it’s beginning to show in very bad ways.

  2. Mike
    February 18, 2011 | 7:23 pm

    Talen an interesting topic. My experience here mirrors yours but I would also add the dispensing of such medicines by pharmacies is even more prevalent. With no doctor involved.

    Last year I also read a fair bit about the use of antibiotics in the farming industry in Thailand, particularly sea food and the knock on effects in the food chain.

    Funnily enough I was going to write a similar post after examining all the stuff in our medicine cabinet recently.

    Now I make Duen give me any medicines she gets for her and Doy and I then research them on the net, this came about after Duen took some tablets from the pharmacy that were for vertigo when she actually had a sore throat ;-)
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    • Talen
      February 21, 2011 | 6:07 pm

      Mike, it does seem odd that pharmacies are allowed to just dole out whatever you think is needed. At least it comes in a box and you know what it is and can look it up if need be. At the clinic you get the lil plastic bags and no real clue what you are taking.

      Vertigo pills for a sore throat is pretty bad though.

  3. Snap
    February 18, 2011 | 8:06 pm

    Talen, public awareness plays a big part in decreasing the over subscription of antibiotics. Like you, I was raised in an era of ‘what doctor says is gospel’, which usually resulted in a good dose of antibiotics. At 25 a dentist showed me the damage from one course of medication I’d taken at 16, on a wisdom tooth he pulled out. Ironically I was having my wisdom teeth removed to avoid tri yearly bouts of tonsillitis which required shots of penicillin in the butt. It worked! No moving teeth, no tonsillitis.

    When I had my own children I made a choice for them and for me. Firstly, do I/they even really need to go to the doctor and two, do I really want those antibiotics in my/their body? No, not unless my leg is going to fall off or my eye is going to pop out.

    I’m happy to report a much cleaner bill of health than yours of late, so can brag that I’ve only needed one mega dose of antibiotics in the last 15 years. I’m hoping my abstinence will help me combat any super bugs in the future, should I need to.

    I know, I know…I do tend to dribble on sometimes!

    • Talen
      February 21, 2011 | 6:04 pm

      Snap, unfortunately Thailand has it in for my tonsils at least!

      I remember when I was a kid they gave us tetracycline and they shouldn’t have…made one of my teeth go black….bad stuff.

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  5. Paul Garrigan
    February 19, 2011 | 6:59 am

    Hi Talen, this is such an important topic. I qualified as a nurse and have seen firsthand what over prescription of antibiotics can do. It makes these drugs useless and this is why we now have problems like Methicillin-resistant Staphylococcus aureus (MRSA) and Vancomycin-resistant Staphylococcus aureus (VRSA). It could easily reach a stage where we once again are unable to treat bacterial infections. I’ve seen people die from necrotising fasciitis (the flesh eating bug) because there was no effective antibiotic treatment. Antibiotics are something that should only be used sparingly, but in Thailand anybody can just walk into a chemist and buy them.

    The other problem is that most people don’t seem to take a full course of antibiotics so this means that their bacterial infection isn’t completely cleared and when it comes back it will be harder to treat. This is a huge threat to not only people in Thailand, but everyone on the planet. Most people don’t even realise how bad this threat is – that’s the scary thing.
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    • Talen
      February 21, 2011 | 6:02 pm

      Paul, I bet you have seen some scary things as a nurse.

      I always finish whatever antibiotic I’m on just because I didn’t once and the strep throat I had came back worse.

  6. Catherine
    February 21, 2011 | 10:04 am


    These days I rarely take drugs but when I do, I buy them direct from a local Thai pharmacy, bypassing the doctor’s visit.

    I’ve had such bad advice from doctors over the years – one had me on antibiotics for three months straight – that I take their ‘knowledge’ with a grain of salt and use common sense instead.

    Especially in Thailand where most of the local doctors I’ve run into seriously believe that they are God’s gift to medicine and should never be questioned. Hah! Get real.
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    • Talen
      February 21, 2011 | 6:00 pm

      Cat, I try to get what I need direct from the pharmacy when I know whats going on and what will work…other times I just don’t wanna guess and end up sicker.

  7. Lani
    February 21, 2011 | 5:43 pm

    you know talen, now that you are a big boy you can go out and buy a lollipop when ever you want to. just sayin’
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    • Talen
      February 21, 2011 | 5:59 pm

      Lani, Just like a woman…always the shopping thing. Besides everyone knows free lollipops taste better and they also make the boo boo’s go away.