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A New Era – Antibiotic Resistance and why all of us need to take it seriously.

Although advances in modern medicine, and healthcare delivery have enabled drugs combating previously life-threatening diseases to become readily available, increasing abuse and overuse of such drugs has resulted in an unprecedented rise of drug-resistant microorganisms. Recent studies have revealed alarming data about antibiotic resistance, with the result that the WHO found it imperative to caution the world of a post antibiotic era – an era in which previously innocuous minor infections such as common cold can once again be lethal.
Until a few years ago, antibiotic resistance was, at best, considered a futuristic prediction – which although made aware to the general public by doctors and health related media, more often than not went unheeded. However, over the past few years, antibiotic resistance has not only become an inevitable reality, but has become a “global health security threat”, as declared by the WHO. Scientists and doctors have already identified about 7 different types of microbes against which no known antibiotic can act.


What is antibiotic resistance?

Antibiotic resistance is the inability of antibiotics to fight against bacteria and other microbes. This is attributed to various causes including poor hand hygiene by hospital staff to incorrect usage or abuse of antibiotics. Once infected, there is little that doctors can do. It turns into an unfortunate game of wait and watch, where doctors and patients can only hope that the bacteria do not cause life threatening diseases. In most cases, the bacteria remain dormant or do not cause much harm, but cases reporting otherwise have been noted as well. In fact, a recent study carried out by doctors in the UK suggests that simple operations like hip replacements could lead to death in one out of six patients, all because of recently surfaced ‘super-bugs’.


Recent trends

While constantly evolving pathogenic microorganisms grow more powerful and antibiotics lose their potency, there has been a discovery void in the search of more potent antibiotic drugs, with no major breakthroughs in the last 3-4 decades (the last major breakthrough antibiotics, Carbapenems, considered to be the most potent antibiotics today, were discovered in 1976). Moreover, Alexander Fleming, the man credited for the discovery of penicillin, had warned about such an apocalyptic resistance to antibiotics. Out of the seven known ‘superbugs’, the one that is reported to be closest home is the New Delhi Metallo- beta- lactamase- 1 or NDM-1, an enzyme (controversially named after the national capital) that makes bacteria resistant to a broad range of antibiotics, including carbapenems. These microbes are responsible for common and serious diseases such as bloodstream infections, diarrhoea, pneumonia, urinary tract infections and gonorrhoea. Even the strongest antibiotics, which are usually used when all others fail, as last resorts, have no effect on these ‘superbugs,’ as described by the WHO. As such, these findings by the WHO are cause for great concern, documenting resistance to antibiotics, especially “last resort” antibiotics, in all regions of the world.

Super-bugs on the rise

When a young Swedish businessman of Indian origin fell ill after visiting India in 2009, doctors assumed it was a regular bacterial infection. But alarm bells had to be sounded when no known antibiotic could help the patient. Doctors administered the strongest, ‘last-resort’ antibiotics but the infection was unscathed. The underlying cause for this immunity of the responsible bacteria to antibiotics has since, been attributed to a new kind of enzyme. One of many of its kind, the New Delhi Metallo-beta-lactamase-1, or NDM-1, as it came to be known, is just one of the 7 known superbugs identified by the WHO. Several cases of antibiotic resistance due to NDM-1 alone have been registered, with at least 3 confirmed deaths. Unfortunately, doctors remain helpless.
One of the reasons why the resistant bacteria spread so rapidly was that they were difficult to detect.Most clinical labs used automated systems to give out microbial results within hours. However, it is only by culturing bacteria over days that a proper determination can be done, of the drugs they are resistant to. Moreover, the automated tests often give misleading results, due to which doctors end up prescribing wrong dosages of antibiotics. Doctors have established that the aforementioned superbugs have the highest tendency to move from person to person, and the problem is severest in the BRIC countries- Brazil, Russia, India and China. The problem is so dire, that a Mumbai based study by the Tata Memorial Hospital concluded that almost half of all bacterial samples from patients are resistant to carbapenems- the most potent antibiotics reserved for emergency use. Carbapenems and many other antibiotics of high potency are already on a list of 536 drugs in India that require a prescription, but the Tata study has shown that such drugs are easy to purchase at retail pharmacies without a physician’s signature. Limited access to basic medical care is one reason for the overuse of carbapenems and other second-line antibiotics. About 70% of India’s 1.2 billion citizens live in rural areas, where, despite government efforts, hospitals are often under-staffed and lacking basic equipment and medication. Rather than relying on physicians, many rural patients turn to local pharmacists and whatever drugs they have in stock. Since surprise checks are rare, pharmacies do not think twice before handing out strong antibiotics either. Moreover, penalties for the crime are not very strict, which makes the menace all the more rampant.

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The very first global report on antibiotic resistance by the WHO in April 2014 reveals a serious threat to public health on a global level. WHO analysed data from 114 countries and concluded that common infections that were easily curable until some time back have become incurable. “Antibiotic resistance is happening in every part of the world and is a serious threat,” is what the report mentions. The report explains that immediate action needs to be taken and ineffectiveness against certain diseases should be a wake-up call for medical practitioners and patients alike. In fact, WHO has even compared the threat of antibiotic resistance with that of global warming, while a few doctors have related it akin to the threat posed by terrorism. Indeed, antibiotic resistance is humankind’s own Frankenstein, created due to reckless consumption, unnecessary prescription, and over-dependence on them.
However, this does not bring us to the end of this issue. Antibiotic resistance is one of the most potent threats the world faces right now and the best way to overcome it is mass awareness on the issue. Stay tuned for our next post in which we go into the depth of the causes of this problem, actions taken by the government and steps which we, citizens of the world can take.

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cloudchowk is a healthcare software company based out of Delhi. Its software help medical labs, clinics and patients share information and collaborate seamlessly.

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