Doctors and patients are abusing antibiotics with impunity. In fact antibiotics and steroids which are two groups of life saving drugs are often used as ‘killer drugs’ by the ignorant patients and callous doctors in most medical conditions in the body. Common colds, fevers, diarrheas, which are often caused by viruses and are self limiting, are treated by one or more potent drugs containing antibiotics and or steroids. Most of them need not be treated with antibiotics or other active agents. Children are frequently down with acute respiratory infections and many parents immediately administer an antibiotic because they do not know that a majority of coughs and colds are viral in origin. Their ignorance is not just about the cause of the disease; it is also about the medicines that they consume. They may have heard of the term “antibiotic”, but often do not know that it is prescribed for an illness caused by bacteria; and they also do not know that it is meant to be taken for a short period of time. Many of the doctors also join this band of ignorance. It is a common knowledge that in the epidemic of viral fevers or eye flue- conjunctivitis antibiotics are freely misused and chemists put ‘out of stock’ signs. A patient came and told, that he was on erythromycin, for eight years. I explained to him that erythromycin is usually only taken for 5-7 days. He replied that he had no idea that it was an antibiotic, and that the chemist had not told him to stop using it. One may argue that only health professionals need to be educated about disease and medicines, but for health to be in truly preventive mode, a basic knowledge of diseases and drugs among patients would go a long way in ensuring appropriate treatment such as appropriate antibiotic use. Due to lack of such awareness, threat of drug-resistant superbugs is looming large over the world, with India being one of the biggest hubs of this global menace. World Health Organization warns that the world is entering an era where minor infection and injury, which were previously manageable with antimicrobials, will cost lives. World Health Organization has recently observed World Antibiotic Awareness Week from November 16 to November 22 aiming at enhancing awareness of global antibiotic resistance and to encourage best practices among the general public, health workers, and policy makers to avoid the further emergence and spread of antibiotic resistance. The tendency of self-medication, non-compliance to treatment regime is a major cause of developing resistance and consequent deaths.
The resistance arises due to misuse of antimicrobials. The more we use the antimicrobials, greater are the chances of developing resistance. But antimicrobials are life-saving. We cannot avoid using them altogether. There is a need to use them only when necessary and prevent the following:
Indiscriminate prescribing and consuming antimicrobial drugs for trivial clinical issues.
Low quality of drugs prescribed or consumed.
Patient’s non-compliance to the prescribed duration of treatment due to negligence or long treatment regime.
The molecular origin of resistance is attributable to spontaneous mutation of the target site of a specific drug. More the organism tries to combat the antibiotic more potent it grows to resist it. ?
Mutation in cellular transport machinery that tries to reject the drug by efflux mechanism, not allowing it to enter the target organism.
The common factors that facilitate the spread of the resistance are: Poor infection control practices, inadequate sanitary conditions, inappropriate food-handling, and Lack of research for developing new antimicrobial agents.
What is greatest killer of recent time?
A recent review by an expert group of the UK government put a lower estimate of total deaths annually due to antimicrobial resistance at 700,000. Antimicrobial resistance will become world’s largest killer by 2050 (lowest estimate, 10 million deaths per year) surpassing cancer (8.2 million). While, in US and EU, around 50,000 people died from antibiotic resistance in 2013, for India, the numbers are frightening. Over 58,000 children died in India in 2013 while the antimicrobial resistance surveillance pegged total deaths in India from this menace at 2 million by 2050, if no action taken.
Antimicrobial resistance increases the cost of health care by lengthening the treatment regime, hospitalization and increasing the prescription load for second line and third line antibiotics. Antimicrobial resistance jeopardizes the health care gain of the society. Without effective antimicrobials for prevention and treatment of infections, the success of organ transplantation, cancer chemotherapy, and major surgery would be compromised. India being a home to common infections, many problems are being faced. Treatment failure for gonorrhea, a potent sexually transmitted infection, to the drug of last resort for third generation cephalosporin has been confirmed. Resistance to one of the most widely used oral antibacterial drugs fluoroquinolones to treat urinary tract infections caused by E. coli is widespread.
Resistance to drugs to treat Staphlo cocci is also widespread. According to the WHO Methicillin-resistant S. aureus (MRSA) has proved to be a great concern, since people with MRSA are 64% more likely to die than people with a non-resistant form of the infection. Klebsiella pneumonia that causes pneumonia, septicemia, and infections in the urinary tract, lower biliary tract and at surgical wound is becoming resistant to drugs in 57% cases. Similarly, multi-drug resistant TB (MDR-TB) is found in 20.5% of previously treated TB cases. Influenza virus, circulating in humans is often resistant to drugs.
This is a wakeup call for the people and the government and specially the stakeholders in medical treatment like patients, doctors, pharmacists, chemists and drug houses to check the menace of drug resistance by rationalizing the use of antibiotics.