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The ABACUS II Consortium, which includes the Medicine Quality Research Group, published a new viewpoint calling for the standardisation of antibiotics appearance and better information around usage. Changes to the appearance of antibiotic medicines could help avoid confusion and reduce misuse. These measures could help reduce antibiotic resistance, an urgent and global problem that is growing every year.

Hand holding multicoloured pills © Credit Ksenia Yakovleva on Unsplash

Although antibiotics work very well against bacterial infections, researchers found they are often used incorrectly. For example, people take the wrong antibiotics against an infection with a certain type of bacteria. The study also found people use antibiotics against an infection or inflammation that is not caused by bacteria, or as a painkiller for menstrual pain or muscle pain. Because this happens on a large scale, especially in low-and-middle income countries, it means that antibiotics may lose their effectiveness.

QR-codes on packaging

The researchers evaluated antibiotic use in three Asian and three African countries. This revealed that antibiotic misuse was widespread. The names under which antibiotics are known is one of the reasons behind this misuse. For instance, in Vietnam, capsule is the literal translation of one of the words for antibiotics. In Mozambique and Ghana this is the case for red-yellow; the colors of a capsule containing a commonly used antibiotic. But not every capsule contains an antibiotic or the same antibiotic. For example, two different types of antibiotics that work against completely different types of bacteria are both contained in red-yellow capsules. In addition, not every antibiotic comes as a capsule, as many are sold as tablets.

Researcher Annelie Monnier, of Radboud University Medical Center, said: “That is why we need to move towards standardisation and better information for users. Consistent use of colors and symbols on pills can help. Logos and QR codes on the packaging are also good options. Particularly because medication often comes without an information leaflet in these countries. Such a QR code should refer to a website with information about the drug. Stickers placed on medication packaging could serve such a purpose. This approach is probably easier and quicker to implement than modifying the pills themselves. You can already pay with QR codes on the market in Thailand and Bangladesh, so the technology is already in use.”

Dr Celine Caillet, Deputy Head of Medicine Quality Research Group, which led the medicine quality aspect of the ABACUS ll project, said: “Antimicrobial resistance is a global worrying problem that needs to be tackled using all possible means. Cultural disparities across countries to identify antibiotics by their physical appearance were identified, potentially leading to their misuse.”

Researchers are also liaising with the authorities involved, such as regulators and drug manufacturers. Medical microbiologist Professor Heiman Wertheim, of Radboud University Medical Center, added: “It is a slow process - until recently, they said ‘all we can do is put a warning on the box’. We think that they can do more. As with so many things, clarity is key. When you provide clarity, people begin to understand it and will be more able to use medicines correctly.”

The full story is available on the IDDO website.

Read the publications 'Is this pill an antibiotic or a painkiller? Improving the identification of oral antibiotics for better use' on The Lancet Global Health website