27 December - 2 Janauary 2014 #687

The silent epidemic

Dhanvantari by Buddha Basnyat, MD

Antibiotics are the wonder drugs of the 20th century. But as organisms become increasingly resistant, the effectiveness of many antibiotics is declining.

Resistance arises as a result of microbes mutating and forming strains that overcome the effectiveness of the antibiotics. One reason these mutant strains form is because of the indiscriminate use of the drugs. In Nepal and India, antibiotics can be easily purchased over-the-counter without a prescription, which leads to overuse and then resistance.

One could argue that in countries like ours where there is a severe shortage of doctors in remote areas, antibiotic use without prescription may be essential in curing illnesses and perhaps even saving lives. However, clear guidelines need to be established and implemented regarding the use of antibiotics with and without prescription.

Another major underappreciated reason for antibiotic resistance in humans is the use of antibiotics in animals (for example tetracycline in chicken feed) in subthearpeutic doses to promote growth. No one knows for sure how antibiotics help animals grow bigger, but one speculation is that suboptimal development caused by unsanitary conditions is compensated by the addition of antibiotics to animal feed.

There are strict regulations in the developed world to curb the practice of adding antibiotics. As early as 1971, on the basis of recommendations made by a committee chaired by Professor Michael M Swann, the UK withdrew authorisation for several substances including tetracycline and penicillin to discourage growth promotion in animals. In 1986 Sweden, which has been a worldwide leader in decreasing antibiotic resistance, banned the use of all drugs meant to increase the size of animals raised for meat. Rest of the Scandinavian countries followed suit in the 1990s. In 2006 all antibiotic-based growth promotion was abandoned by the European Union. Surprisingly, none of these rulings affected the market for animals raised for meat.

The US Food and Drug Administration recently introduced a major policy to phase out the indiscriminate use of antibiotics in cows, pigs, and chicken raised for meat. There is data to show that about 23,000 Americans die annually from antibiotic-resistant infections.

Since the 1970s, health officials had warned that the overuse of antibiotics in animals was leading to the development of infections resistant to treatment in humans. However, whenever federal officials tried to reduce the use of antibiotics in animals, the powerful food industry and its substantial lobbying power in the Congress was successful in countering these moves.

Many antibiotic-resistant infections are also common in the developing world. From urinary tract infections to neonatal infections, doctors in Nepal and India are finding it more difficult to treat these common diseases with the old standby antibiotics. They now have to resort to the next generation of more powerful and expensive antibiotics setting the stage for a time when ultimately all antibiotics lose their usefulness.

One important way of dealing with this problem would be to follow what Ramanan Laxminarayan, a leading scholar and vice president for research and policy from the Public Health Foundation of India, recently suggested when he was in town. It is time for even countries like India and Nepal to use antibiotics in animals only for treatment of infections. Indiscriminate, subtherapeutic use for growth promotion must be stopped by the respective governments so that antibiotics meant for saving human lives continue to be effective.

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