Article by Professor Dr. Baharudin Abdullah
Senior Consultant, Department of Otorhinolaryngology - Head and Neck Surgery
Universiti Sains Malaysia (USM)
In Malaysia, as in many other countries worldwide, there is a growing concern over a silent, yet widespread epidemic caused by the excessive and often inappropriate use of antibiotics. This issue is particularly evident in the treatment of sore throats, which are usually the result of viral infections and do not require antibiotics. The widespread overprescription of these medications has serious and extensive consequences, leading to a troubling increase in antibiotic-resistant superbugs that pose a significant threat to public health.
The misuse of antibiotics can lead to a rise in mortality rates and exerts a significant burden on the healthcare infrastructure and economy, draining resources and complicating treatment efforts across the board. It is more critical than ever to enhance public awareness and promote responsible prescription practices to protect public health and ensure the continued effectiveness of existing antibiotics.
The World Health Organization's Global Antimicrobial Resistance and Use Surveillance System (GLASS) has categorized Malaysia as a high-alert nation due to the increasing threat of antimicrobial resistance (AMR). In comparison to other Asian countries, Malaysia is among the leading nations in terms of antibiotic overuse, akin to Thailand and China, where obtaining antibiotics without a prescription remains a prevalent issue.
The Ministry of Health Malaysia has consistently raised alarms about the escalating issue of AMR, yet the trend of overprescribing antibiotics remains prevalent due to several key factors:
- Patient Misconceptions: Survey shows that 67.2% of Malaysians mistakenly believe antibiotics can cure viral infections, and 34.8% think they are effective for pain relief (Kong, Islahudin Muthupalaniappen and Chong, 2021).
- Doctor Practices: Many physicians in both public and private primary care settings are often influenced by patient expectations and diagnostic uncertainty, leading to the prescription of antibiotics even when they are not clinically indicated (Rahman, Teng and Sivasampu, 2016).
In Malaysian hospitals, the challenge of AMR is becoming increasingly apparent, with a surge in drug-resistant strains like Methicillin-resistant Staphylococcus aureus (MRSA) and Carbapenem-resistant Enterobacteriaceae (CRE) (Ministry of Health, 2017)). This predicament results in extended hospital stays, increased healthcare expenses, and a greater chance of treatment failures. Treating a resistant infection can be up to three times more expensive than a non-resistant one, placing a substantial financial burden on both patients and the healthcare system.
In addition to its effects on healthcare, AMR has major economic and environmental consequences. According to World Bank estimates, by 2050, AMR may cause the world economy to contract by as much as 3.8%, which might result in the poverty of 28 million people. The need for more costly second-line therapies and extended hospital stays will drive up prices for the already overburdened healthcare system. Furthermore, the environmental impact is too great to overlook because overprescribed antibiotics frequently end up in wastewater, contaminating soil and rivers and facilitating the spread of antibiotic resistance in bacterial populations outside of hospital settings.
While the statistics paint a grim picture, Malaysia is not without recourse. The country has already made significant strides in public health, from implementing national antibiotic stewardship programs to conducting public awareness campaigns. However, these efforts need to be scaled up and reinforced with a long-term, multi-sectoral approach. Strengthening enforcement of antibiotic sales, improving diagnostic capabilities in primary care settings, and fostering stronger collaboration between healthcare providers, policymakers, and the public are critical next steps. Malaysia has a strong track record of advancing healthcare, which puts it in a unique position to lead efforts domestically and throughout Southeast Asia in the regional fight against AMR. Since Malaysia has already made great progress in improving healthcare—from bolstering universal healthcare laws to spearheading programs for managing infectious diseases—it can support a regional AMR action plan that unites ASEAN countries in concerted efforts to stop antibiotic abuse. By advocating for stricter cross-border regulations on antibiotic sales, harmonising prescription guidelines, and championing large-scale public awareness campaigns, Malaysia can set the benchmark for responsible antibiotic stewardship in Southeast Asia.
At this critical juncture, Malaysia has the opportunity to become a regional powerhouse in the battle against AMR with strong leadership and swift action. Malaysia has the potential to set a regional model for sustainable antibiotic usage by driving regulatory reform, encouraging cross-sector collaboration, and embracing new innovations in technology. As part of this effort, we are preparing for the official public and media launch of the Malaysian Sore Throat Consensus - an initiative supported by Reckitt - to further drive awareness and encourage responsible prescribing practices. This consensus, grounded in the latest clinical evidence and multi-disciplinary expert recommendations, is a crucial step in guiding healthcare professionals towards better decision-making when it comes to antibiotic use. Despite the pressing need, with the right policies and measures in place, Malaysia can safeguard public health and steer ASEAN toward a future in which antibiotics remain effective for future generations.
