Antibiotic Resistance: A reality.

Resistance to antibiotics develops when pathogenic organisms mutate into a more dangerous form which the regular antibiotic is unable to kill.

Dec. 5, 2014, 5:45 p.m. Published in Magazine Issue: Vol: 08 No. -12 December. 5- 2014 (Mansir 19, 2071)

Antibiotic resistance (ABR) means that common infections no longer effectively respond to the usual antibiotics, necessitating the use of more powerful antibiotics. Unfortunately often these strong antibiotics are also unable to resolve the infection leading to complications and death in a patient. 

That ABR is no longer a threat but a reality is abundantly clear. Everyday in medical outpatient clinics to intensive care units( ICU) doctors are often required to use the latest generation of antibiotics  to deal with mutant strains of what used to be a straightforward infection to treat. Common examples are urinary tract infections in the outpatient clinic and pneumonias in the ICU setting.

Resistance to antibiotics develops when pathogenic organisms mutate into a more dangerous form which the regular antibiotic is unable to kill. Then, the resistance genes of the pathogen start to circulate in the community. This spread is facilitated by poor hygiene in hospitals and homes, increasing global travel and medical care abroad, and also due to interspecies gene transmission with misuse of antibiotics in animals.

Many Western countries, especially the Scandanavians, have realized that this is a very serious problem akin to malaria, HIV, and TB. But without the help of developing countries this worldwide problem is not going to go away because of increased frequency of global travel. This problem needs to seriously dealt with by the health ministries in the developing world. The World Health Organization is trying to play a pivotal role in this regard.

Many people including doctors think that there is an unending supply of many different antibiotics with many in the pipeline.Nothing could be further from the truth. Chiefly because producing new antibiotics is not as lucrative as discovering new drug for chronic diseases like cancer or heart diseases, drug companies have over the years shied away from investing in making new antibiotics.  So at least for now we are left with the antibiotics we have got.  Hence proper usage is important. 

Unfortunately in countries like Nepal and India, antibiotics ( even the most potent ones) can easily bought over the counter; and often there is also under dosing of the antibiotics which all leads to increased resistance.

In many countries there are no national policies regarding ABR like there is for HIV and malaria. The lack of these national policies is a good example of as how lightly the issue is being taken. The first step would be to carry out proper surveillance of ABR so that the trend of the resistance can be plotted and understood for rational use of antibiotics.

The other important emphasis has to be given to microbiology in the developing world. This is a neglected field as most health care professionals use empirical antibiotics for infectious diseases without microbiological back up. There are obvious reasons of lack of resources for following this approach; hence oneobvious wayis for drug companies, governments and  health research charities to invest in what is referred to as  “rapid diagnostics” and make them inexpensive.

Rapid diagnostics are point of care tests that can be done with a high degree of accuracy with the results promptly available.

For example, in typhoid fever, there are no quick, reliable tests ( the blood culture may take a week) to make a diagnosis, hence doctors use a variety of antibiotics to clear the unknown fever which is conducive to ABR. 

ABR is here to stay, and we have to get our act together; otherwise it will be the dawning of a postantibiotic era.

Buddha Basnyat.jpg

Buddha Basnyat MD

Buddha Basnyat, MD, MSc, FACP, FRCP, Director of the Oxford University Clinical Research Unit-Patan Academy of Health Sciences, Kathmandu.

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