THE BACTERIAL THREAT AS A RESULT OF ANTIBIOTIC MISUSE
APRIL 18, 2019 @ 7.08 PM
Imagine a global healthcare crisis that could cause up to 10 million deaths yearly and more than $100 trillion in healthcare costs by 2050. What could cause such a situation? The answer is antimicrobial resistance (AMR). This happens when microorganisms (bacteria, fungi, viruses and parasites) change after exposure to antimicrobial drugs (antibiotics, antifungals, antivirals, antimalarials and anthelmintics). Therefore, these treatments become ineffective and the infection sustains, increasing the risk of spread to other people.
Associate Professor Dr Sasheela Sri La Sri Ponnampalavanar, Consultant Infectious Disease Physician (pix) says the impact of infections due to multidrug resistant bacteria is catastrophic.
"Without effective antimicrobials, many standard medical treatments will fail or turn into very high-risk procedures. It impedes the achievements of modern medicine, compromising the success of organ transplantation, cancer chemotherapy and major surgeries."
“According to The Review on Antimicrobial Resistance, if we do not take prompt action, we threaten the future of our public health. By 2050, the 10 million people that are estimated to die of AMR is more than the current combined mortality rate for cancer, diabetes and road traffic accidents. Asia will face the greatest impact of 4,730,000 deaths by 2050."
Antibiotics fall under the category of antimicrobial drugs. Resistance happens when germs like bacteria and fungi develop the ability to defeat the drugs designed to kill them. Failure responding to antibiotics could result in prolonged illness, increased cost and even increased risk of death.
“We face a challenge whereby patients have a misconception that antibiotics can solve any infection. However, these drugs are only meant to treat infections caused by bacteria such as streptococcus throat infection, whooping cough and abscesses," said Sasheela.
She further explained that it has no effect on viral infections such as influenza, common colds and dengue.
"It is not only ineffective in combating the virus but could also attack the antibiotic sensitive beneficial bacteria in the body promoting the overgrowth of resistance bacteria. Additionally, the resistant bacteria can transfer their resistant genes to the sensitive bacteria in our body."
Challenges of antibiotic resistance
We are now seeing more infections that do not respond to most antibiotics and some that don’t respond to any antibiotics. To make matters worse, as the rate of global antibiotic resistance increases, the pipeline for new antibiotics is drying up. There are very few options to treat resistant pathogens and there are times where we do not have any options.
“I have personally experienced patients who suffer from AMR, most of them have been exposed to multiple courses of antibiotics. Once a person is exposed to an antibiotic and develops resistance, the resistance can remain in the body for a long time, at times more than a year. These patients are more difficult to treat, they need prolonged intravenous antibiotics therapy, and the outcome is generally poor."
Antibiotics are also known as "societal drugs", as antibiotic resistance can pass from bacterium to bacterium, and resistant bacterial infections can pass from one person to another.
When antibiotics are used in humans or animals, approximately 80 - 90% of the ingested antibiotics are not broken down but passed through the body intact and enter the environment as waste. They retain their ability to affect bacteria and promote antibiotic resistance even after they enter the soil or water as a waste product. Thus, antibiotic use and antibiotic resistance can eventually affect an entire community.
What can we do to prevent AMR?
If you have a bacterial infection, it is important that you complete the antibiotics as prescribed by your doctor to prevent emergence of resistant bacteria and partial infection treatment.
“Overall, antibiotic use must be controlled. Physicians, pharmacists, and the general public must avoid careless use of these precious drugs. Antibiotics must be prescribed only for bacterial infections and in the proper dose for the correct amount of time.
Sasheela emphasised that patients should try to stay with one doctor until the infection has been resolved and avoid ‘doctor shopping’. They should also ask their doctor what they have been prescribed and why so. By law, the name of the antibiotics (or any prescribed drug) should be written clearly on the prescription pack along with the dose and duration.
"With antibiotics, you have to complete the entire course of the medication. Do not save antibiotics to use at another time. It’s important to understand not all antibiotics are the same, each has a different mechanism of action. Therefore, it is vital for doctors to identify the site of infection and determine if the infection is likely to be bacterial before prescribing or recommending antibiotics,” she concluded.
The role of immunisation
The World Health Organisation has highlighted vaccination as an important way to tackle antibiotic resistance. As AMR continues to be pervasive, new classes of antibiotic discovery in the last 25 years are scarce. Assuming recent pipeline initiatives are successful, these new drugs are still highly subjected to resistance.
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