A few years ago the World Health Organization published this anonymous bit of doggerel titled “The History of Medicine.”
2000 B.C. – Here, eat this root.
A.D. 1000 – That root is heathen. Here, say this prayer.
A.D. 1850 – That prayer is superstition. Here, drink this potion.
A.D. 1920 – That potion is snake oil. Here, swallow this pill.
A.D. 1945 – That pill is ineffective. Here, take this penicillin.
A.D. 1955 – Oops . . . bugs mutated. Here, take this tetracycline.
1960-1999 – 39 more “oops.” Here, take this more powerful antibiotic.
A.D. 2000 – The bugs have won! Here, eat this root.
An executive in his mid-thirties developed a stomach upset and diarrhoea after a meal. He consulted his company doctor and left the clinic with six little white packets -two types of antibiotics, two types of painkillers a small white pill for diarrhoea, and a pink tablet to be chewed three times a day. He was flabbergasted. ‘I thought I only needed something to control the diarrhea until I got home.’ This case could be repeated in many hospitals anywhere, reflecting the inappropriate and excessive use of antibiotics.
Why? It shows that there is abuse of antibiotics in treating patients because doctors are prescribing them excessively. Similarly, a recent study showed that over 90% of patients who received antibiotics did not really need them.
Once it was thought that antibiotics would help us wipe out forever the diseases caused by bacteria. But the bacteria have fought back by developing resistance to many antibiotics. The misuse and overuse of antibiotics has given rise to the serious problem of antimicrobial resistance worldwide. While doctors and, to a much lesser extent, patients must take the blame, it is principally a problem caused by the ruthless drive of drug companies in their quest for super profits The indiscriminate use of antibiotics without prior culture sensitivity testing and over-the-counter availability of most of the medicines has resulted in disastrous levels of antibiotic resistance in our Valley as well.
From our experience at Department Of Microbiology, SKIMS Hospital Bemina, we have come to observe that pathogens causing urinary and respiratory tract infections have acquired antibiotic resistance to most of the routinely prescribed drugs. Penicillins like Amoxicillin, Ampicillin have now become ineffective and so have other commonly prescribed drugs like Erythromycin, Norfloxacin and Ciprofloxacin. Multi-drug resistance is of particular worry with most of the strains of E.coli, the commonest causative agent of urinary tract infections having become resistant to two or more class of drugs. Similarly, the Methicilin Resistant Staphylococcus aureus (MRSA), prevalence is on rise in valley and sadly enough the microbe is resistant to almost all the available routine antibiotics except a few very costly and high-end drugs.
Reckless use of third generation Cephalosporins like Ceftriaxone, to treat even minor infections and taking the medications for insufficient durations is making this class of drugs increasingly ineffective now. In majority of the cases, the problem is that the antibiotics are stopped once the symptomatic cure has been achieved although the duration for taking the antibiotic course had to be in accordance with the attainment of proven bacteriological cure. The persisting microbes once survive the onslaught of medications mutate and acquire resistance to all the drugs of that particular class making the treatment on recurrence very difficult.
Similar results have been seen in studies published from SKIMS Soura, where resistance to one of the most potent class of antibiotics, called fourth generation Cephalosporins has been noticed to be on rise. That means in near future, the use of Vancomycin, Linezolid, Quinopristin, drugs that happen to our last resort against the invading microbes might have to used as first-line regimen, baring the Achilles heel of the mankind for the fatally virulent microorganisms. And in that case, unless the search for newer generation of antibiotics yields results, we would not be able survive a boil on the hand or a graze on the knee, catapulting us back into themiseries of pre-penicillin era.
Scientists are warning of a “post-antibiotic era,” in which antibiotics will no longer be able to fight disease. Experts say the potency of most antibiotics has already begun to wane. There’s an arms race between the drugs and the bugs, with the drugs trying to keep up but unfortunately not being able to keep pace with the ever rising rate of antibiotic resistance. The sad part is not only that antibiotic are sometimes used to treat viral infections, against which they are impotent but also that they are used as “props” when safer methods like sanitation and even simple hand washing might be preferable.
Misuse also arises because the drug is so easily available outside the doctor’s clinic, especially in developing countries. Given the lax restrictions and enforcement there, antibiotics are sold in black markets and in pharmacies over the counter to people who can afford them and use them as they please by under- or overdosing themselves.
Part of the antibiotic misuse is fostered by the drug companies which zealously promote the medicine as a cure-all in order to sell as much as possible against rival products. What results is uncontrolled drug promotion, leading to a pill-for-every-ill syndrome and the irrational use of drugs. No one is spared from medical representatives. They will give free samples, and many will invite doctors to social occasions, to dinner. They’ll even take care of spending for trips abroad, for medical conferences. Even if the local doctors are not completely convinced by the drug’s efficacy, unfortunately they feel grateful for the first-class treatment and overwrite certain useless drugs.
Is there a way to fix the antibiotic resistance problem before some little bug fixes us? The answer is yes.
-Doctors should prescribe the most specific antibiotic possible. Targeted, or “narrow-spectrum,” antibiotics will kill the offending bug without sparking resistance among other bacteria living in the patient. This would call for greater use of susceptibility testing — exposing colonies of human pathogen to various antibiotics to see which kill the bacteria.
-Many people quit taking the drugs after the symptoms of their infection have disappeared, but some partly-resistant microbes might remain. If you quit taking your meds at that point, you’re allowing the partly-resistant organisms to survive and multiply.
-Use of common antibiotics first. If they work, there will be no need to expose the bugs to more recherché drugs.
-Improve infection control in hospitals. In other words, kill the bugs before they get inside patients. That can be done with ultraviolet lights, better sanitation, and putting patients with recalcitrant infections in isolation wards.
In addition, we need stricter policies to deal with the problem of over prescription, inappropriate and uncontrolled use of the drug and overzealous promotions by drug companies.
At the same time, governments and medical bodies should devise means and programmes to monitor, evaluate, control, and prevent hospital-based infections, while providing training and consultation for medical personnel on the appropriate and safe use of antibiotics. As antibiotic resistance knows no national boundaries, they should link up and cooperate with their counterparts, agencies and NGOs at home and abroad mutual in surveillance, research and training. Infectious disease specialists are hoping that new attention to the problem will lead to changes that slow the inevitable rise of resistance. The general prescription for controlling the problem includes changes in medical behavior to protect the power of existing anti-microbial weapons, increased research to find new killers for the little infectious killers, and reductions in non-medical uses.