The threat of resistance to antibiotics
Antimicrobial Resistance (AMR) simply means that the antimicrobial medicine (say, antibiotic) you used before is not effective anymore against the disease you are suffering from; even if given at the right dose for the right duration. It means that you have developed resistance to that particular antibiotic. One disease may develop resistance to a number of antibiotics (e.g. Muti Drug Resistant TB) that in the course of time, the choice of antibiotics available for that disease becomes limited.
AMR is posing a serious threat to the treatment of malaria, TB, sexually transmitted infections, hospital associated infections, epidemic prone diseases like cholera, typhoid, acute respiratory infections, etc. People with AMR stay sick longer, duration of treatment is longer and treatment cost also increases.
Among a number of factors responsible for the rise of AMR, inappropriate use of antibiotics is one of the most common causes. 50% of the patients do not comply with the treatment advised and 50% of the antibiotics are prescribed inappropriately. In a study conducted in and around Delhi, 25% of the responders said that they would stop the antibiotics once they start feeling better before the completion of recommended course. 53% would prescribe antibiotics for self and family members and 18% would save unused antibiotics for later use. Doctors sometimes prescribe antibiotics unnecessarily in cases of cold and diarrhea. Common cold or diarrhea can be of viral origin and antibiotics may be unnecessary in such cases. Sometimes, antibiotics are prescribed on patients’ demand or to please the patient. Lack of laboratory facilities for culture and sensitivity test (to detect the causative organisms and test their sensitivity to antibiotics) compels practitioners to go for blanket treatments using broad spectrum antibiotics.
In Nagaland, AMR is a reality although data is less and there are only a few laboratories to directly detect AMR. In a recent (2011) study conducted among 34 doctors in 8 district hospitals in Nagaland, 97% of the respondents think that they may be missing cases of AMR for lack of laboratory facilities. 30% of the respondents said that they have detected AMR in their hospital in the last 12 months. Although there is no data, it’s a fact that many people go directly to the pharmacies. They ask for certain antibiotics, or explain their illness to the pharmacist who prescribes on the spot. Some of these pharmacists may not be trained but through experience know a few about what to give in some illnesses. Many opt to go to pharmacies straightaway to avoid hospital’s long queues, laboratory tests, etc to save time and money. The issue of poor health care delivery system is a complicated and a long standing issue. But the point here is that antibiotics procured directly through pharmacies can be a factor causing AMR. In Nagaland, I think this is a serious area which needs study, spread of awareness and legislation if necessary.
The economic impact of AMR is huge. WHO lists them as loss of productivity (loss in income, diminished worker productivity, time spent by family) and increased cost of diagnostics and treatment (consultation, infrastructure, screening, cost of equipment, drugs). Health care is already strained due to rising non-communicable diseases (like Diabetes, Cancers, Cardio- Vascular Diseases), emerging and re-emerging communicable diseases (HIV/AIDS, Bird/Swine Flu, Malaria) and other conditions adverse to health like Accidents, Ageing population, Global Warming, Disasters, etc. In addition to these, the threat that AMR poses to health is of the enormity that health care can be pushed back by about a century to the pre-antibiotic era.
What can we do about the threat of AMR? Next time you catch a cold or suffer from loose motion, think twice before you decide to go for that familiar antibiotic. Common cold and Diarrhea are often of viral origin in which antibiotics may be of no use. So, consult your doctor and don’t self medicate. Then, what the doctor prescribes, complete the course even if you are already feeling better. For the caregivers, some of the things that can be done are: Study of the trend of AMR and improved surveillance; provide laboratory facilities to hospitals for AMR detection; have a Standard Treatment Protocol for doctors; sensitization of doctors and (more importantly) private pharmacists on the problem of AMR; legislations to check antibiotic use without prescription and overzealous advertisement/promotion of brands by pharmaceutical companies; rationalize antimicrobial use in veterinary sector, promote rational use through sensitization and education; etc.
Antimicrobial agents, like other natural resources are limited and should be used judiciously and rationally. Individuals’ decision to misuse this ‘common good’ put whole communities and future generations in jeopardy.