The Antibiotic Apocalypse!

By Ravi Chandra Dasari,
MSc, Molecular Biology
Uppsala University, Sweden

“Antibiotic resistance is one of the major issues affecting modern medicine and its ability to preserve public health against infectious diseases. India is the world’s largest consumer of antibiotics for human health, the next largest consumers are China and the US.”

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Antibiotic resistance is one of the major issues affecting modern medicine and its ability to preserve public health against infectious diseases. A growing number of infections such as pneumonia, tuberculosis and gonorrhoea are becoming harder to treat as the antibiotics used to treat them have become less effective. Antibiotic resistance has been plaguing countries across the globe. India is the largest consumer of antibiotics in the world. The lack of proper regulatory mechanisms, lack of proper sanitation, increase in income and cheap over-the-counter distribution of antibiotics has led to the rampant growth of resistant infections. Overuse of antibiotics is a major driving force in the growth of resistance in microbes.

antibiotic-trends
Trends in antibiotic consumption in India, 2000-2010

What are antibiotics?

Antibiotics are medications used to treat and prevent bacterial and fungal infections. Antibiotics can be of two types: Bactericidal and Bacteriostatic. Bactericidal antibiotics kill the bacteria and bacteriostatic antibiotics prevent the bacteria from replicating any further and arrest their multiplication. There are different types of antibiotics given, based upon their effectiveness against various infections diseases. Broad spectrum antibiotics are the those which are effective against a wide range of bacteria, ex: Amoxicillin, Aminoglycosides, Tetracyclines, etc. Narrow spectrum antibiotics are specific to certain families of bacteria, ex: Azithromycin, Erythromycin, Vancomycin, etc.

What is antibiotic resistance?

Antibiotic resistance is the ability of a microbe to withstand effects of therapeutic levels of antibiotics. It is analogous to an “arms race” between the effectiveness of an antibiotic and the respective microbes’ ability to evolve under such selective pressure to survive and replicate successfully. As diverse as human beings are, we pale in comparison with the adaptability of microbes, which inhabit literally every possible climate and environment on the planet. From the microbial perspective, human beings are nothing more than walking microbial planets; there are 10 times more microbes living on and in every human being than there are human cells in our bodies. Because of this extraordinary diversity of habitat, microbes comprise fully 60% of the biomass on the planet (90% if cellulose is excluded from the calculation), despite their sub-micron size. Microbes have had 3.5 billion years to adapt to the various environmental pressures on planet Earth. The power that drives microbial adaptability is genetic plasticity and rapid replication. It takes many bacteria only 20 min to replicate; it takes human beings 20–30 years to replicate. It is absurd to believe that we could ever claim victory in a war against organisms that outnumber us by a factor of 1022, that outweigh us by a factor of 108, that have existed for 1000 times longer than our species, and that can undergo as many as 500,000 generations during 1 of our generations. Hence it should come as no surprise that microbes successfully evolve and adapt to selective pressure created by antibiotics fairly quickly.

MRSA under a microscope

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How is antibiotic resistance proliferating?

Unfortunately nowadays some doctors routinely receive compensation from pharmaceutical companies and pharmacists in exchange for antibiotic prescriptions . Infection control and hygiene in hospitals is poorly monitored and could be improved. Over-the-counter access to antibiotics is a problem, but regulations to restrict access have to be balanced against the need to maintain access for the significant proportion of the population that lacks access to doctors. Improper dosages and self medication further increase the chances of microbes gaining resistance. Recent studies in various regions of India have discovered antimicrobial residues in food & animal products (such as chicken, meat and milk), indicating that antibiotic use in food animal production is widespread. There are no standards for tolerance of antibiotic residues in poultry and other livestocks.

antibiotics-work
How antibiotic resistance happens?

What can we do to prevent antibiotic resistance?

Individuals can:

  • Only use antibiotics when prescribed by a certified health professional.
  • Never demand antibiotics if your doctor says you don’t need them.
  • Always follow your doctor’s advice when using antibiotics.
  • Never share or use leftover antibiotics.
  • Prevent infections by regularly washing hands, preparing food hygienically, avoid close contact with sick people, practicing safer sex, and keeping vaccinations up to date.

Government can:

  • Ensure a robust national action plan to tackle antibiotic resistance.
  • Improve surveillance and tracking of antibiotic resistant infections.
  • Strengthen policies and implementation of infection prevention and control measures.
  • Regulate and promote the appropriate use and disposal of antibiotics.
  • Create awareness and provide information on the impact of antibiotic resistance.

Health Professionals can:

  • Prevent infections by ensuring your hands, instruments, and environment are clean.
  • Only prescribe and dispense antibiotics when they are needed.
  • Inform individuals regarding proper dosage and use of antibiotics.
  • Spread awareness regarding prevention of infectious diseases.

HealthCare Industry can:

  • Invest in R&D of new antibiotics, vaccines, diagnostics and other tools.

Food & Agriculture Industry can:

  • Only give antibiotics to animals under veterinary supervision.
  • Not use antibiotics for growth promotion or to prevent diseases.
  • Vaccinate the animals to reduce the need of antibiotics.
  • Promote and apply good practices at all steps of production and processing of foods for animal and plant sources.
  • Maintain hygienic conditions at all times.

Conclusion

Every year, at least 7,00,000 people die from drug resistant infections. It is why government scientists have described antibiotic resistance as one of the greatest global threats of the twenty-first century. Recent studies suggest that the numbers will reach 10 million by the year 2050. United Nations has come forward and recently declared antibiotic resistance as a ‘fundamental threat’ to global health. Antibiotic resistance has the capability to send medical science back to the bronze ages.

India is the world’s largest consumer of antibiotics for human health, the next largest consumers are China and the US. These countries need to regulate the use of antibiotics by creating policies at the central level and set an example for other developed and developing nations to follow. Countries should be capable  of tracking each antibiotic resistance outbreaks at a granular level. Without sustainable investment in the development of novel antibiotics, the war against bacteria and other microbes cannot be won. International borders become meaningless and the spread of a new superbug (resistant to all known antibiotics) will prove to be unstoppable with our limited repertoire. We should take this issue seriously or else be prepared to bear the wrath of an antibiotic apocalypse.  “Survival of the fittest” as the saying goes.

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Author: Flebie

Flebie is a diagnostic healthcare startup striving to bring care back into healthcare. We at Flebie are striving to make healthcare more accessible, convenient, transparent and affordable.

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