In the international medical news last week, there was a great deal of alarm caused by some resistant bacteria that infected western patients in India, who had come to the country for treatment. Such incidents could potentially threaten the medical tourism industry of India, which has been progressing by leaps and bounds Ė a jump of almost 30 per cent every year.
These resistant bacteria have been found to trigger urinary tract infections in India. Even Nepali doctors have detected such instances here that have become increasingly difficult to treat. Doctors believe that the infection here may have been introduced from India, but this remains to be investigated.
One bacterium among this resistant army is E. Coli. It appears that E. Coli has fortified itself with a special enzyme called the New Delhi metallo betalactamase (NDM), which makes it resistant to regular antibiotics such as ciprofloxacin. In fact E. Coli, doctors have found, is not only resistant to regular antibiotics, but also the Ram Banh of antibiotics Ė the extremely effective but expensive carbapenems. This is worrisome, because the antibiotic armamentarium against more dangerous strains of the usually harmless E. Coli could be fast diminishing.
India is understandably worried that the lucrative industry of medical tourism may be negatively affected by the advent of these 'superbugs'. Although the article in The Lancet Infectious Diseases that broke this story on 11 August focused on India, Pakistan and the UK, it is unclear as yet if this problem exists in other parts of the world. Only time and further studies will tell.
Regardless of how NDM plays out, it is clear that in our part of the world, there are several practices regarding antibiotic usage that may exacerbate the risks. Antibiotics in Nepal, unlike in the West, can be easily bought over the counter. This leads to misuse, and eventually resistance to antibiotics. Our future government will clearly need to have better control over the sale of antibiotics. In addition, patients need to be educated about antibiotics and their side effects. Finally, doctors need to guard against polypharmacy, which is the common practice of prescribing too many medicines or antibiotics to treat a single disease in a patient. All of these measures will help in preventing the rise of sinister enzymes such as NDM, and retain the effectiveness of treatments.