13-19 June 2014 #711

Antibiotic resistance: a reality

Dhanvantari by Buddha Basnyat, MD

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

It is abundantly clear that ABR is a reality. Every day in medical outpatient clinics to intensive care units (ICU) doctors are required to use the latest generation of antibiotics to deal with mutant strains of what used to be ordinary bacteria causing the common urinary tract infections or pneumonias for example.

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 local 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 Scandinavians, have realised that this is a very serious problem akin to malaria, HIV, and TB and have taken appropriate action. But without the help of developing countries this worldwide problem is not going to go away because of increased frequency of global travel. International health agencieslike The World Health Organization need to more effectively address this serious problem.

Many people including doctors erroneously think there is an unending supply of many different antibiotics with many more in the pipeline. Producing new antibiotics is not as lucrative as discovering a new drug for chronic diseases like cancer or heart diseases, and drug companies have shied away from investing in making new antibiotics. For now we are left with the current batch of antibiotics, hence their proper usage is important.

Unfortunately in countries like Nepal and India, even the most potent antibiotics can easily be bought over the counter. Both their overuse as well as under-dosing of the antibiotics leads to increased resistance.

In many countries there is no national policies regarding ABR like there is for HIV and malaria. The lack of these national policies is an example of how lightly the issue is taken. The first step to establish a policy 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.

In the developing world, the other important emphasis has to be given to microbiology. This is a neglected field due to lack of resources. But drug companies, governments and health research charities can change that by investing in “rapid diagnostics” and also 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 to make a diagnosis since blood cultures may take a week. Therefore doctors use a variety of antibiotics to clear the unknown fever which is conducive to ABR, when they could be using a reliablerapid diagnostic test to help administer a specific antibiotic.

Proper diagnosis and treatment is fundamental to maintaining the effectiveness of antibiotics, but it appears ABR is here to stay unless we get to work now.

Read also:

The return of the microbes Sunir Pandey

Multiple resistance

The silent epidemic

Superbugs

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