Antibiotic resistance: it’s all in the misuse

Is there anyone who has never taken an antibiotic? The answer, of course, is 'no'. From common cold to life threatening infections like sepsis, antibiotics are taken either with or without prescription. Here are some questions and statements most of us can relate to.

Why shouldn’t I take antibiotics if I have infections like sore throat or diarrhoea? Why don't some infections get better despite taking antibiotics? My friend got better, so I bought the same antibiotic from my next door pharmacist. Aren’t antibiotics supposed to be a “panacea” for all infections? Answer to all these questions is a 'no'.

Antibiotics are meant to be given only for treatment of infections caused by bacteria; they don’t help in viral infections. Each case scenario is likely to be different and the drug-bug combination varies; so an antibiotic that helped your friend may not help in treating your infection.

Antibiotics are not a panacea for all infections, and in the present scenario, probably not even for all bacterial infections because bacteria have developed increased resistance to antibiotics! It is estimated that about 10 million people are likely to die annually by 2050 due to complications related to antibiotic resistance.

What went wrong? Why is there an increased antibiotic resistance? Bacteria are known to have antibiotic résistance, either intrinsic or acquired through mutation or gene transfer. However, frequent, irrational and indiscriminate use of antibiotics have added to the problem and led to increase in antibiotic resistance.

There are two scenarios. First, when you take antibiotic for infections not caused by bacteria, the antibiotic comes in contact with commensal (good) bacteria in your gut and kills some of the susceptible ones, leaving behind resistant ones. These resistant commensal bacteria, in due course, increase in number and lead to further spread of antibiotic resistance to infection-causing bacteria. Two out of three healthy Indians tested, were found to harbour antibiotic resistant bugs in their gut, according to a recent study published by ICMR.

Second, even if antibiotic is prescribed for bacterial infection but not in standard dose or for complete duration, it will not completely kill all the infecting bacteria and the bacteria which survive may change and develop resistance. In addition, indiscriminate use of antibiotics in agriculture, poultry, fisheries, dairy industry and veterinary disciplines has worsened the situation. Further, these antibiotic resistant bacteria spread due to many reasons, like poor infection control practices in hospitals, poor hand hygiene, lack of food safety, international/ local travel etc.

What lies ahead?

Consumption of antibiotics in our country has more than doubled from 2000 to 2015 — India is supposedly the world’s largest consumer of antibiotics. Antibiotic-resistant bacteria especially the “superbugs” are causing fatal infections and we are on the verge of approaching post-antibiotic era!

Infections caused by bacteria, ranging from urinary tract infection and abscesses to life threatening meningitis and sepsis, all require treatment with last resort antibiotics and thereby escalate the cost of treatment, need for hospitalisation, added morbidity and mortality.

Is there an escape from ESKAPE (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumonieae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter species) pathogens?

Moreover, it has been a dry pipeline as far as pharmaceutical industry is concerned, there have been no new antibiotics introduced in the recent years. So, how is the problem going to be addressed?

The Union government has included certain antibiotics in new schedule H1, which mandates the drugs to be taken in accordance to medical advice. In 2016, the government launched a multimedia campaign “Medicines with red lines” to create awareness on rational use of medicines (including antibiotics) which carry a red line on their strip. In 2016 , the prime minister in Mann Ki Baat highlighted the problem of antibiotics in India.

In 2017, ICMR issued “Treatment Guidelines for Antimicrobial Use in Common Syndromes”, which act as general guidelines for treatment of common infections. Hospital are coming up with antibiotic policy and antibiotic stewardship programmes which aid in minimising antibiotic resistance. Any antibiotic prescribed should be the right drug, at right time, in right dose, by right route and for right duration, so that emergence of resistance can be prevented.

With healthcare expenditure at 1.2% of GDP, the scenario for antibiotic resistance in our country is gloomy. Breaking the chain of transmission of antibiotic resistance is imperative. Antibiotics are prescription-only medicines. Handle them with care and help them do their job!

(The writer is Assistant Professor, Department of Microbiology, Victoria Hospital, Bangalore Medical College and Research Institute)