WHEN Wu Yu found she had a sore throat, she thought it was

the early symptom of a cold. So she immediately took a couple of Amoxicillin (an antibiotic) she had obtained in a drugstore without prescription.

Two days later, she stopped taking the drug after the symptom receded. If her sore throat flared up again, she still had more of the antibiotic which was there to be shared by all members of her family.

However, she was unaware that she was misusing the antibiotic and that she could also be harming her health. The Amoxicillin may be no longer an effective treatment for her sore throat in future.

In most Western countries, antibiotics are only obtainable on prescription. However, in China, the drugs can be obtained in pharmacies as easily as chewing gum.

You get a fever. You have diarrhoea. You catch a cold. Take a couple of Amoxicillin or Norfloxacin. Who needs a doctor?

Misuse and abuse

"Shanghai has become one of the worst centres in China where bacterial resistance is quite severe due to misuse and abuse of antibiotics," said Professor Zhang Yongxin, vice-director of Antibiotics Research Institute at Huashan Hospital.

According to data from the city's Drug Administration, the consumption of antibiotics in Shanghai has reached 35 per cent of total medical expenditure. About 80 per cent of local households have antibiotics in the home.

In hospital wards, between 50 and 80 per cent of in-patients are on antibiotics, far higher than the global average of 30 per cent.

"Many customers buy antibiotics without a prescription," according to a pharmacist in Huashi Pharmacy. "They think it's more convenient and cost-saving to take several pills at home rather than consulting a doctor."

The causes of the health crisis are complicated and varied and involve doctors, patients and pharmaceutical companies.

Doctors choose antibiotics randomly without finding the exact cause of the illness or they use new and advanced wide-spectrum antibiotics even if a narrow-spectrum drug would be effective.

In surgical operations, some doctors rinse incisions with liquid antibiotics. Some in-patients are on antibiotics all the time they are in hospital.

Doctors are also under pressure from patients who have the misunderstanding that expensive medicines are always better than cheap ones.

"Some patients order me to prescribe some cephalosporin although I explain that such medicines are too strong. I have no way out but to prescribe the medicine otherwise they would quarrel with me," said a doctor.

Another problem troubling some doctors is that patients do not follow instructions when taking antibiotics. Once some patients start to feel a little better, they put the drugs in the bathroom leaving some bacteria alive in their bodies. Several days later, the illness returns and the surviving bacteria have changed their genetic make-up to become much stronger in resisting the drugs.

Dr Zhang said that Wu's action in taking antibiotics at random was especially dangerous because the bacteria may have become quite resistant when she finally consults a doctor.

Some antibiotic pharmaceutical companies are worsening the abuse of the drugs by illegally giving a commission to doctors or hospitals for using their drugs.

Before the implementation of the Drug Administration Law last year, advertisements about various antibiotics were published in the media, so that patients were misled about the right drug to choose. The ill effects of that ad campaign still lingers on and won't be eradicated in the short term.

Health crisis

Besides the huge medical waste, the untoward effects of using antibiotics is increasing rapidly. One statistic says that of the 192,000 deaths due to side-effects of drugs in China, about two thirds were due to antibiotics.

But the more serious problem is bacterial resistance to antibiotics which has snowballed into a serious public health concern globally.

Within the decade after penicillin was discovered in 1928 by Alexander Fleming, antibiotics were seen as wonder drugs able to wipe out many potentially life-threatening bacterial infections.

But the Age of the Miracle Drug is now dead and the indiscriminate use of the antibiotics is leading human beings to back to a most frightening era - the return of infectious diseases for which there is no effective treatment.

"Penicillin used to be effective to treat any infection but nowadays, over 80 per cent of the staphylococcus are resistant to the drug; about 33 per cent of pseudonomas aeruginosa are resistant to gentamicin," said Professor Jiang Jian, vice-director of Shuguang Hospital.

The problem of drug-resistant bacteria is even worse in children. Doctors of Shanghai Bawu Hospital found a shocking case in a 10-year-old girl patient suffering from urinary tract infection. Tests showed that the bacteria were resistant to 12 kinds of antibiotics.

Increasing levels of drug resistance are threatening to erode the medical advances of recent decades, according to a report from the World Health Organization (WHO). The report describes how almost all major infectious diseases are slowly but surely becoming resistant to existing drugs.

It took 20 years to develop penicillin for medical use, and then 20 years for the drug to become virtually useless for treating gonorrhea in most parts of the world.

Dr David Heymann from WHO once warned that the world might only have a decade or two to make optimal use of many of the medicines presently available to stop infectious diseases.

Up till now, scientist have developed more than 200 types of antibiotics, but human beings are now literally in a race against time to bring levels of infectious disease down worldwide, before the diseases wear the drugs down.

Solve the problem

Dr. Jiang, as member of Revolutionary Committee of Kuangmintang Shanghai, is preparing a proposal for this year's Shanghai Political Consultative Committee Conference calling for stricter management on antibiotics.

First, effective public education in proper use of the drugs. Second, research into quicker identification of bacteria (which is popular in the West) should be sped up so that doctors can apply the correct antibiotic.

The key issue is to map out regulations which would include detailed guidance (such as dosage, types and treatment courses) for the use of antibiotics and which would also cover the operations of various medical departments, doctors' qualifications to write prescriptions and the sale and availability of antibiotics.

Government policy is to give strong support to the solving of the problem. Many hospitals are under government pressure to control their medical costs and unnecessary and expensive use of antibiotics make them the first drugs to be cut off.

In Shuguang Hospital, the use of advanced antibiotics requires the permission of the hospital's medical affairs office which has resulted in a large drop in their use.

Jiang said that controlling antibiotics abuse was going to be a long process and the work needed to be done for several generations. The task needed the co-operation of the whole society.