Abuse of antibiotics proving costly

I believe my mother lost a one-year-old son to simple diarrhoea in the year 1922. That was the Pre antibiotic era when children and adults succumbed to simple infections which turned fatal with no cure.

Had she lived today, she would have seen them dying from a more deadly form of the same infection set off by the overuse of antibiotics. We have arrived full circle. What was a boon to mankind has turned into a demon, threatening to spawn killer diseases in the post anti biotic era.  A  21st century gift to mankind, with infections like pneumonia, TB, typhoid and cholera no longer responding to medical treatment – thanks to the indiscriminate use of powerful antibiotics which were life savers in this country since the Forties.

Estimates show that India records over 400,000 deaths every year from pneumonia alone. More than 1,000 young adults are said to die of tuberculosis every day. The number of fatalities and hospitalisations due to an untreatable form of diarrhoea known as C-Diff go unrecorded. For a country of a billion plus, this may appear a trivial issue. But, it is a sad reflection on the laxity of rules regarding the perils of misusing life saving drugs. According to WHO, minor ailments could become fatal and major operations become impossible to perform with serious infections becoming drug resistant.

Free access

Barring morphine perhaps, people in this country have free access to all kinds of drugs despite the policy of the health ministry to stop the misuse of third and fourth generation antibiotics. According to rules, drugs have to be labeled as Schedule H or X or H X. The first is for prescription drugs only. The second to be used in hospitals under the supervision of physicians. The third is to be marked dangerous and not sold in retail.

But, how effectively is this policy implemented?  We can buy antibiotics freely. We give them to animals to act as growth promoters and to boost milk production. These antibiotics find their way into our own bodies to defeat their purpose when needed in an emergency. The Centre for Disease Control and Prevention has sounded another alarm bell. It has categorised drug-resistant ‘super bugs’ by threat level stating that more than two million people will get antibiotic-resistant infections each year, and thousands will die because current drugs can no longer stop their infections.

The Medical Council of India has made continuing education in the use of antibiotics compulsory, not only for fresh graduates but for all practicing physicians who want their licenses renewed. But, doctors are not the only culprits. Pharmacists, distributors and patients themselves are guilty of abusing antibiotics by selling them over the counter without a prescription, distributing free samples indiscriminately and swallowing them through self medication – in that order. Educational approaches to the problem may be a good idea, but they are slow and ineffective. In developing countries like ours, where levels of education and literacy are abysmal, halting offences with red warning lights and deterrent punishment for violation of rules, seems the only answer.

Deaths which could easily have been prevented but for the resistance posed by the irresponsible use of life saving drugs for treating a common cold or any other viral infection. Not only do doctors prescribe them assuming that they will lose their patients otherwise, but patients themselves try to save the doctor’s consultation fee by turning to the friendly pharmacist who has no compunction in prescribing and selling antibiotics to his unwary customers. Worse, many patients store them and self medicate without the least idea of how to take these drugs or for what duration.

A couple of days of this treatment and they feel better which is the green signal for them to stop the medication. Antibiotics which saved lives in this country against deadly bacterial infections like meningitis and tuberculosis in adults, or dysentery and cholera in children, will soon become faded snapshots of the past with bacteria becoming more and more resistant to them. No wonder India has been named the world leader in bacterial diseases.

All it takes is a simple understanding of bacteria and the wars they wage in times of illness. Most of them die when assaulted with powerful antibiotics. If these are withdrawn, some of the surviving bacteria multiply very fast and emerge stronger than before. They become resistant and refuse to succumb the next time their antibiotic enemy strikes. The very same antibiotics which worked miracles now become powerless when a serious infection arises. All the life threatening diseases of the last century will return with no cure if we continue to abuse the greatest gift of scientific discovery to mankind – a small pill to overcome deadly infections.