Concurrent use of traditional medicine and prescribed antibiotics and/or antiviral medicines and their effects on antimicrobial resistance and treatment failure in Ilembe district, Kwazulu-Natal province, South Africa.
Kadima, Mukanda Gedeon.
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Background: Traditional herbal mixtures are generally available, affordable and commonly utilized in developing and developed countries and usually utilized as self-care treatments. However, its incorrect use can lead to fatal outcomes. Antimicrobial resistance (AMR) is driven by many factors such as the careless use of prescribed antimicrobial medicines and the use of traditional medicine, with the result that there is always the danger of misadministration, interaction, and toxicity. AMR is also considered as the major cause of treatment failure and is largely responsible for the declining in eradication rates of infectious diseases worldwide. Individuals may consult both traditional healer practitioners (THPs) and biomedically trained healthcare professionals (BHPs) for the treatment of their bacterial and viral infections. This study aimed at determining whether any antimicrobial resistance and treatment failure could occur among patients, attending outpatient departments of selected healthcare facilities, who used concurrently prescribed antimicrobial medicines and traditional medicine in the Ilembe district, South Africa Methods: This study was a cross-sectional descriptive study using a mixed method approach. First phase was a qualitative study using an interview face to face with a questionnaire. One hundred and thirty two respondents were included with four (4) types of participants: Traditional health practitioners (THPs), Patients seen by THPs, biomedically healthcare professionals (BHPs) and outpatients. Second phase was a quantitative study using a medical chart review of 400 patients’ medical records and who attended the outpatient department in two public healthcare facilities between February and March 2018. Antimicrobials prescribed alone or in association with other medicines and concurrent use of traditional medicine were assessed and reported using descriptive statistics. Where applicable, associations were carried out; a p-value ˂0.05 was estimated as statistically significant. Results: This study found a small number of medicinal plants used by traditional healer practitioners for treating infectious diseases of patients seen by them. The majority of traditional healer practitioners and their patients (21/32, 65.62%) mixed different herbs for the treatment of infectious diseases. Traditional healer practitioners and patients seen by them agreed that the combination of both traditional medicines and prescribed medicines for infectious diseases may lead to interactions, adverse effects; infectious diseases may get worse if the time lapses between the two medicines do not exist. However, biomedically healthcare professionals and outpatients reported that combing traditional with prescribed medicines for infectious diseases may result in drug resistance, especially resistance to antibiotics and they highlighted that the majority of patients came to the clinic with several complications such as kidney failure, vomiting, diarrhoea and jaundice after using either TM alone or in combination with prescribed medicines. Besides the perception phase of this study, 400 outpatients’ medical records were documented from two different municipalities, many participants had viral infections (194/400, 48.50%). Overall, 12% of participants (48/400) had documented negative clinical outcomes with adverse effects (30/48) and interactions (18/48). A few participants (15/400, 3.75%) had used traditional medicine in conjunction with prescribed medicines. Among those who used both traditional medicine and prescribed medicines, the majority (80%, 12/15) had documented adverse effects due to the concurrent use of traditional medicine and prescribed medicines. After adjustment, documented adverse effects and interactions were significantly more likely due to the use of traditional medicine (AOR = 0.01, 95% CI = 0.001-0.05) and (AOR = 0.21, 95% CI = 0.37-1.23) respectively. Conclusion: From perceptions stated by respondents in this study, the concurrent use of conventional and traditional herbal medicines may interfere or result in damaging some organs, failure of therapeutic effects and modification of pharmacological actions of administered medicines. Traditional medicine was sparingly used in conjunction with prescribed antimicrobials for viral and bacterial/fungal infectious diseases. However, adverse effects and interactions such as herbal intoxication, persistent rashes, and treatment failure were documented in few medical chart records among outpatients attending the two selected healthcare facilities. Further studies are needed to investigate the effects of concurrent use of traditional medicine and prescribed medicines in other parts of South Africa.