“Make sure you take the antibiotics 2 times per day, after breakfast and dinner for a week. Look out for some side effects like rash, vomiting, stomach pain, ear ache or diarrhoea. Come into the hospital if any of them occur” said the Doctor.
I’m sure a lot of you can recognize this familiar dialogue when you walk out of the hospital or a clinic.
You had walked in with a cold or cough that has been bothering you since 1-2 days. You drank warm water, ate bland food and tried every home remedy of your grandmother. None of them seem to work, well, at least not instantly. Now your subconscious mind wants some antibiotics to get rid of it. (Some even opt to consult Dr. Google!) Most of us know that antibiotics can make us feel a bit uneasy at times, even though the results might be instantaneous.
But do we know the most deadly side effect of the antibiotic –the rise of antibiotic resistant bacteria or ‘superbugs’- that the whole world is facing?? It definitely not one of the side effects you’ll experience as soon as you pop in a pill. It’s a side effect that is like a dormant volcano, waiting to explode, without prior warning.
As a medical doctor, it’s a common experience for me to have someone amongst my family or friends calling (or worse, texting) regarding a cough or cold that they developed recently. Mostly, it is to ask “which antibiotic to take?” rather than “what’s causing the symptoms?”
What fuels them to do so is the easy access to antibiotics over the counter, at least in most parts of the developing countries. We have failed to understand that this one act has led to the emergence of an invisible army of bacteria which pose a dangerous threat to the very existence of mankind. It has been predicted by O’Neill report commissioned by the British government, that more people could be killed by antibiotic-resistant bacteria than cancer by 2050. According to a study done in 2016 in India, nearly 60,000 newborns were killed by antibiotic-resistant bacteria.
“What doesn’t kill you makes you stronger”.
This holds true not just for humans, but also for antibiotic-resistant bacteria aka “Superbugs”.
What are superbugs? In simple terms, they are bacteria that cannot be killed by a majority of the available antibiotics. They are also synonymously called the ‘multidrug resistant bacteria’. These have evolved from the bacteria that have adapted and made the antibiotics less useful. Antibiotic resistance is a natural phenomenon. It’s purely a case of ‘survival of the fittest’ in the microbial world. However, its progression has been accelerated to a great extent in recent times leading to rise of the deadly superbugs.
Antibiotics have helped us fight deadly infections like pneumonia, tuberculosis, gangrene, etc. in the past. But not all infectious diseases are caused by bacteria. They can be caused by viruses, fungi, or protozoa against which antibiotics are useless. The first ever antibiotic, Penicillin, was discovered by Alexander Fleming in 1928. Fleming himself had warned us about the consequences of their possible overuse – “The thoughtless person playing with penicillin treatment is morally responsible for the death of the man who succumbs to infection with the penicillin-resistant organism”. Unfortunately, we have been negligent of his words for over 90 years, only to realize the severity of what he meant.
The major causes for the emergence of antibiotic-resistant bacteria include
- inappropriate use in humans, including over-prescription, prescription for non-bacterial illnesses, and failure to complete a course of treatment,
- in livestock farming to produce more milk and meat
- and improper disposal of drugs into the environment
This constant circulation of excess antibiotics builds a fertile breeding ground for the bacteria to mutate and become resistant to drugs.
Doctors tend to over-prescribe antibiotics mainly due to the fact that patients have high expectations of it. Many doctors will agree that their knowledge regarding medicine was questioned when they simply followed clinical protocol and refused to prescribe antibiotics. Some patients even opt for a second consult just to make sure that they do not need antibiotics. This clearly indicates that there is an urgency to feel better among patients. Sometimes, this is aggravated by the fact that there is the uncertainty and delay in the diagnosis to confirm the source of infection.
In the developing countries, the high patient-doctor ratio is also one of the major reasons for antibiotics over prescription, especially in the outpatient setting. The doctor, being extremely fatigued, would choose to prescribe the antibiotics rather than provide a lengthy and time consuming explanation of why it’s not needed.
Pharmaceutical companies compete with each other by urging and incentivizing doctors to prescribe their antibiotics. Such actions heavily influence the attitude of doctors regarding the frequency of antibiotic prescription. According to the recent reports by the US Food and Drug Administration, a lot of pharmaceutical companies have withdrawn from participating in the research and manufacturing of new antibiotics and are concentrating on drugs for chronic diseases like cancer. This might be due to the fact that antibiotics are used on an average for 2-weeks whereas drugs for chronic diseases are used lifelong, thereby increasing their liability.
The last commercial antibiotic was developed in 1980’s. This means that the development of newer antibiotics has slowed down. Every time an antibiotic is prescribed, the chance of prescribing another higher antibiotic on the next sick visit increases. And a day will come in the future when there will not be a higher antibiotic to prescribe and mankind may slowly drift right back to the pre-antibiotic era.
The government should take appropriate measures and impose strict rules and regulations regarding manufacturing and prescription of antibiotics, both in medical and agricultural settings, and also tighten its grip on the availability over the counter. There needs to be a check over the quality of the active ingredients in antibiotics as well as on its safe disposal. Governments in countries like British and China have recently set up research funds to encourage scientists in developing new supercharged antibiotics to fight these superbugs. The US food and drug administration in 2017 and European Union in 2006 have banned the use of antibiotics as growth promoters in animal feed. Alas, the world is big global village now and the flow of antibiotics is easy between countries. Therefore, it is important that all nations come together and participate in a global action plan against fighting the deadly superbugs.
Doctors should be given more time and space to establish a strong doctor-patient relationship, to be able to educate their patients and create awareness regarding the use of antibiotics. Doctors should prescribe antibiotics – the right kind with right dosage -only if needed. Doctors should not let their judgment be clouded because of the agreements they may have with pharmaceutical companies. Hospitals should have a better infrastructure regarding infection control.
The common man needs to understand that antibiotics are not ‘magic pills’ for every ailment. The next time you come down with a cough or cold, do not self medicate. Visit the doctor (quit calling/texting), get examined thoroughly and take antibiotics only if advised. And if prescribed, do not forget to complete the full course. Do not share your antibiotics and do not use the leftovers. If the cold or cough is viral, don’t pressure your doctor into prescribing an antibiotic. Wait for a couple of days to feel better. Eat healthy and sleep well in the meantime. Give a chance for your immune system to get strong. Our body is naturally programmed to fight such infections without the help of antibiotics, which might make the situation worse. Don’t overlook long term risks for short term benefits. Make sure to wash your hands regularly to avoid spreading and contracting infections.
It won’t be long before these Superbugs start making their celebrity appearances in DC comics as antagonists and the superheroes will need more than just their superhuman powers, or rather a better antibiotic, to fight them.
These superbugs will claim lives faster than chronic diseases, global climate change or terrorism. Doctors will not be able to carry out life saving operations and the ICUs will not be sterile environments anymore. It’s time actions are taken swiftly so that we can slow down this drug resistance, if not stop it completely. This might give time for scientists to come up with newer alternatives to fight the superbugs. If not, antibiotic-resistant bacterial infection will not just remain confined to few cases but will turn into a global epidemic in the near future.
In the meantime, let’s stop using antibiotics unnecessarily and kill the ‘good bacteria’ in our gut. Keep it reserved only for the nasty ones. Let each one of us try to contribute our share in this battle by creating awareness among our peers regarding the spread of antibiotic resistance.
(P.S- There is also an android and iOS mobile game called the “Superbugs” that mirrors the real world battle against antibiotic resistant bacteria. It also contains science facts to give a broader understanding of the issue and what they can do to personally tackle it. Take a break from the fantasy games and check this out!)
Dr. Nidhi Shekhar
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