Antibiotic resistance a major health problem world faces today

Rawalpindi

Antibiotic resistance has emerged as a serious issue globally and threat to global public health because without effective antibiotics, the success of major surgery and even cancer chemotherapy would be compromised and the cost of health care for patients with resistant infections would be higher than care for patients with non-resistant infections due to longer duration of illness, additional tests and use of more expensive drugs.

Globally, around 480,000 people develop multi-drug resistant TB each year, and drug resistance has already started complicating the fight against HIV and malaria as well.

Professor and Head of Community Medicine at CMH Lahore Medical College Dr. Muhammad Ashraf Chaudhry expressed this while talking to ‘The News’ in connection with World Antibiotic Awareness Week being observed from November 14 to 20 around the globe with an aim to create awareness about the global threat and to encourage best practices among general public and health care providers to avoid serious losses, the antibiotic resistance is causing.

The theme of the campaign, Antibiotics: Handle with care, reflects the overarching message that the antibiotics are precious resource and should be preserved. They should be used to treat bacterial infections, only when prescribed by a certified human or animal health professional. Antibiotics should never be shared or saved for the future.

It is important that easy availability of antibiotics over the counter without doctor’s prescription in Pakistan had promoted self-medication and this has resulted the overuse and misuse of antibiotics increasing the development of resistant bacteria. Antibiotic resistance threatens the effective prevention and treatment of an ever-increasing range of infections caused by bacteria, parasites, viruses and fungi, said Dr. Ashraf.

He said the antibiotic resistance occurs when microorganisms such as bacteria, viruses, fungi and parasites change in ways that render the medications used to cure the infections they cause ineffective. When the microorganisms become resistant to most antimicrobials they are often referred to as “superbugs”. This is a major concern because a resistant infection may kill, can spread to others, and impose huge costs to individuals and society.

He added that without effective antimicrobials for prevention and treatment of infections, medical procedures such as organ transplantation, cancer chemotherapy, diabetes management and major surgery (for caesarean sections or hip replacements) become very high risk.

Among the reasons identified by the World Health Organisation behind rise in antibiotics resistance are widespread misunderstandings about the problem and causes, including the abandonment of treatment halfway, the ease with which antibiotics are available without prescription in many countries, and their indiscriminate use.

Dr. Ashraf said there are more than 600,000 quacks operating across the country in Pakistan. Quacks prescribe and administer heavy antibiotics and steroids for quick results and a fast buck. This practice in addition to development of antibiotic resistance also damages liver, kidneys and testes, he said.

He added that antibiotics are also prescribed for treating colds and flu by unqualified practitioners, despite fact that antibiotics have no effect on the viruses. “Majority of people stop antibiotics when they feel better, rather than completing the prescribe course of treatment.”

To a query, he said antibiotic prescription in cases pertaining to children between one year and 15 years may be as high as 89 percent. Their prevalent use has made antibiotics almost ineffective against the infections they are manufactured for, he said.

He added resistance to antibiotics has reached dangerous levels globally and also in Pakistan and if left unchecked, it will mean the end of modern medicine as we know it. It means humanity is hurtling towards a post-antibiotic era in which common infections will once again kill, said Dr. Ashraf.

It is important that the rise of antibiotic resistance is a global health crisis and it has emerged as one of the greatest challenges for public health today. It is reaching dangerously high levels in all parts of the world. Antibiotic resistance is compromising our ability to treat infectious diseases and undermining many advances in medicine, said Dr. Ashraf.

He said antibiotic resistance spreads to the general public in two ways. One when antibiotics are given to patients, which can result in drug resistant bacteria developing in the gut. Patients attend hospitals or clinics and spread drug-resistant bacteria to other patients through poor hygiene and unclean facilities.

He added another way is that antibiotics are given to food producing animals and crops. Animals develop drug resistant bacteria in their gut. Drug-resistant bacteria reach humans through food, the environment (water, soil, air) or by direct human-animal contact. This results drug-resistant bacteria spread to the general public, explained Dr. Ashraf.

Talking of remedies, he said the issue needs to be highlighted at a higher level to save people from an unending vicious circle of infectious diseases as the re-emergence of infectious diseases era has started.

“As a public health professional, I urge policy makers to formulate sound policies on antibiotic prescription, and over the counter sale and save the people of Pakistan from a time when no antibiotic would be able to cure infections,” he said.

He added a more short-term practical approach to prevent antibiotic resistance especially in countries like Pakistan is that only qualified doctors should be authorized to prescribe them and only when necessary.

“Moreover, it should be ensured that antibiotics to animals -- including food producing and companion animals -- are only used to control or treat infectious diseases and under veterinary supervision,” he said. Animals should be vaccinated to reduce the need for antibiotics and develop alternatives to the use of antibiotics in plants.

Dr. Ashraf said general public should be educated through media to only use antibiotics when prescribed by certified health professional. Always take the full prescription, even if you feel better. Never use leftover antibiotics. Never share antibiotics with others. Prevent infections by regularly washing your hands, avoiding contact with sick people and keeping your vaccinations up to date, he said.

He added that health workers can also play part in preventing infections by ensuring that their hands, instruments and environment are clean. Keep your patient’s vaccinations up to date. If you think patient might need antibiotics, where possible, test to confirm and find out which one. Only prescribe and dispense antibiotics when they are truly needed. Prescribe and dispense the right antibiotic at the right dose for the right duration, suggested Dr. Ashraf.