Microbes, the undying killers

They have made good use of human beings' weaknesses like unnecessary use of antibiotics.

Antibiotics are substances that inhibit and/or kill microbes that are harmful. More than that antibiotic just love to be in the news. When Alexander Fleming made the discovery in 1928, they made huge news, to the extent few even believed that this will be the end of all infectious diseases. Antibiotics again made news in 1943 when bacterial strains having previously acquired antibacterial-resistant genes were demonstrated. This was when the dream of conquering infectious diseases by use of antibiotics was shattered and the medical world was at a loss. 

This was just the beginning because they made headlines repeatedly with a vengeance. In December 2009 the international media widely reported the ‘discovery’ of New Delhi Metallo-beta-lactamase-1 (NDM-1) or more popular as ‘Super Bug’ -- an enzyme that makes bacteria resistant to a broad range of antibiotics. The NDM-1 was reported globally and an article appeared on the issue in the prestigious Lancet, 2010. The political leadership of India shot back that it was an insult to use the name of any place as this would hurt the sentiments of the people and that India was safe for all medical care including surgeries. In reality the government was worried about the country’s medical tourism business, a 2 billion dollar industry. 

In August 2012, the first-ever meeting of medical societies was held in Chennai on the issue of resistance and developing a clear cut plan to formulating a road-map to tackle the global challenge of antimicrobial resistance from the Indian perspective. This came to be called the ‘Chennai declaration’. Under the guidance of World Health Organisation (WHO) the strategic technical advisory group on Antimicrobial Resistance (STAG–AMR) held its first meeting in September 2013, at WHO’s headquarters in Geneva. The advisory group members were unanimous in calling for urgent action to address the growing public health threat from AMR. Responding to all these issues our health ministry announced in September 2013 that it had framed the policy to address the problem of multi-drug resistance.

Consequences of resistance 

The drug-resistant tuberculosis has become a public health crisis, the WHO has declared, with the number of people diagnosed with the deadly airborne disease rising so fast that some countries don't even have enough drugs or medical staff to treat them all.

According to the WHO, India is home to 73,000 patients with MDR-TB (multi drug resistance – tuberculosis). The figure for XDR-TB (resistance to all  tuberculosis medicines) is not yet known and the government refuses to accept that they are there. Seven per cent of all new TB patients in Mumbai did not respond to any known tuberculosis medication and this could be a nationwide phenomenon. XDR-TB is perhaps the most deadly form of TB since there are no medicines at all to treat them. 

There is also increasing resistance to drugs for HIV/AIDS. The latest figure for drug resistance is not known but in May 2007, when around 47,000 people were reported to be on ART, some 3000-5000 patients had become resistant to treatment. There is hardly any analysis as to why this is happening. And if there is any analysis, it is not in the public domain. The second line treatment requires stronger systems for monitoring.

There is a much larger malaise with regard to the abuse of antibiotics. Fifty percent of antibiotics are overused and misused by physicians and patients across the country. Forty three per cent patients self-medicate with one out of four not even finishing the course. Antibiotic resistance is a multifaceted problem and hence needs a multipronged attack. Firstly there is an urgent need to build confidence in the medical profession by training young doctors on its public health importance. Equally urgent is the necessity to take into confidence the various medical professional bodies. Every hospital should have antibiotic usage guidelines and implement the same. 

The pledge to implement the policy should be crystal clear and not just reduce it to a piece of another document catching dust as it happens most of the time. Thirdly, plenty of antibiotics are also used in veterinary practices. How do we reign in this? The USA regulatory authorities have already started working by reducing consumption of antibiotics in all animal feeds. Last but not the least there is an urgent need to educate the consumer. 

The changes suggested may mean even a change in our lifestyle. Are we ready? If not remember that microbes will outsmart all of us. Microbes have been extremely smart and have already threatened human beings. Microbes have made good use of the human beings’ weaknesses like not sticking to policies and unnecessary use of antibiotics. So we better change!

(The writer is president of the Drug Action Forum, Karnataka)

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