| A few years ago the World Health Organization | | | | baring the Achilles heel of the mankind for the |
| published this anonymous bit of doggerel titled | | | | fatally virulent microorganisms. And in that case, |
| "The History of Medicine." | | | | unless the search for newer generation of |
| 2000 B.C. - Here, eat this root. | | | | antibiotics yields results, we would not be able |
| A.D. 1000 - That root is heathen. Here, say this | | | | survive a boil on the hand or a graze on the knee, |
| prayer. | | | | catapulting us back into themiseries of pre-penicillin |
| A.D. 1850 - That prayer is superstition. Here, drink | | | | era. |
| this potion. | | | | Scientists are warning of a "post-antibiotic era," in |
| A.D. 1920 - That potion is snake oil. Here, swallow | | | | which antibiotics will no longer be able to fight |
| this pill. | | | | disease. Experts say the potency of most |
| A.D. 1945 - That pill is ineffective. Here, take this | | | | antibiotics has already begun to wane. There's an |
| penicillin. | | | | arms race between the drugs and the bugs, with |
| A.D. 1955 - Oops . . . bugs mutated. Here, take | | | | the drugs trying to keep up but unfortunately not |
| this tetracycline. | | | | being able to keep pace with the ever rising rate |
| 1960-1999 - 39 more "oops." Here, take this | | | | of antibiotic resistance. The sad part is not only |
| more powerful antibiotic. | | | | that antibiotic are sometimes used to treat viral |
| A.D. 2000 - The bugs have won! Here, eat this | | | | infections, against which they are impotent but |
| root. | | | | also that they are used as "props" when safer |
| An executive in his mid-thirties developed a | | | | methods like sanitation and even simple hand |
| stomach upset and diarrhoea after a meal. He | | | | washing might be preferable. |
| consulted his company doctor and left the clinic | | | | Misuse also arises because the drug is so easily |
| with six little white packets -two types of | | | | available outside the doctor's clinic, especially in |
| antibiotics, two types of painkillers a small white pill | | | | developing countries. Given the lax restrictions and |
| for diarrhoea, and a pink tablet to be chewed | | | | enforcement there, antibiotics are sold in black |
| three times a day. He was flabbergasted. 'I | | | | markets and in pharmacies over the counter to |
| thought I only needed something to control the | | | | people who can afford them and use them as |
| diarrhea until I got home.' This case could be | | | | they please by under- or overdosing themselves. |
| repeated in many hospitals anywhere, reflecting | | | | Part of the antibiotic misuse is fostered by the |
| the inappropriate and excessive use of antibiotics. | | | | drug companies which zealously promote the |
| Why? It shows that there is abuse of antibiotics | | | | medicine as a cure-all in order to sell as much as |
| in treating patients because doctors are | | | | possible against rival products. What results is |
| prescribing them excessively. Similarly, a recent | | | | uncontrolled drug promotion, leading to a |
| study showed that over 90% of patients who | | | | pill-for-every-ill syndrome and the irrational use of |
| received antibiotics did not really need them. | | | | drugs. No one is spared from medical |
| Once it was thought that antibiotics would help us | | | | representatives. They will give free samples, and |
| wipe out forever the diseases caused by bacteria. | | | | many will invite doctors to social occasions, to |
| But the bacteria have fought back by developing | | | | dinner. They'll even take care of spending for trips |
| resistance to many antibiotics. The misuse and | | | | abroad, for medical conferences. Even if the local |
| overuse of antibiotics has given rise to the serious | | | | doctors are not completely convinced by the |
| problem of antimicrobial resistance worldwide. | | | | drug's efficacy, unfortunately they feel grateful |
| While doctors and, to a much lesser extent, | | | | for the first-class treatment and overwrite certain |
| patients must take the blame, it is principally a | | | | useless drugs. |
| problem caused by the ruthless drive of drug | | | | Is there a way to fix the antibiotic resistance |
| companies in their quest for super profits The | | | | problem before some little bug fixes us? The |
| indiscriminate use of antibiotics without prior | | | | answer is yes. |
| culture sensitivity testing and over-the-counter | | | | -Doctors should prescribe the most specific |
| availability of most of the medicines has resulted | | | | antibiotic possible. Targeted, or "narrow-spectrum," |
| in disastrous levels of antibiotic resistance in our | | | | antibiotics will kill the offending bug without |
| Valley as well. | | | | sparking resistance among other bacteria living in |
| From our experience at Department Of | | | | the patient. This would call for greater use of |
| Microbiology, SKIMS Hospital Bemina, we have | | | | susceptibility testing -- exposing colonies of human |
| come to observe that pathogens causing urinary | | | | pathogen to various antibiotics to see which kill |
| and respiratory tract infections have acquired | | | | the bacteria. |
| antibiotic resistance to most of the routinely | | | | -Many people quit taking the drugs after the |
| prescribed drugs. Penicillins like Amoxicillin, Ampicillin | | | | symptoms of their infection have disappeared, |
| have now become ineffective and so have other | | | | but some partly-resistant microbes might remain. |
| commonly prescribed drugs like Erythromycin, | | | | If you quit taking your meds at that point, you're |
| Norfloxacin and Ciprofloxacin. Multi-drug resistance | | | | allowing the partly-resistant organisms to survive |
| is of particular worry with most of the strains of | | | | and multiply. |
| E.coli, the commonest causative agent of urinary | | | | -Use of common antibiotics first. If they work, |
| tract infections having become resistant to two | | | | there will be no need to expose the bugs to |
| or more class of drugs. Similarly, the Methicilin | | | | more recherché drugs. |
| Resistant Staphylococcus aureus (MRSA), | | | | -Improve infection control in hospitals. In other |
| prevalence is on rise in valley and sadly enough | | | | words, kill the bugs before they get inside |
| the microbe is resistant to almost all the available | | | | patients. That can be done with ultraviolet lights, |
| routine antibiotics except a few very costly and | | | | better sanitation, and putting patients with |
| high-end drugs. | | | | recalcitrant infections in isolation wards. |
| Reckless use of third generation Cephalosporins | | | | In addition, we need stricter policies to deal with |
| like Ceftriaxone, to treat even minor infections | | | | the problem of over prescription, inappropriate |
| and taking the medications for insufficient | | | | and uncontrolled use of the drug and overzealous |
| durations is making this class of drugs increasingly | | | | promotions by drug companies. |
| ineffective now. In majority of the cases, the | | | | At the same time, governments and medical |
| problem is that the antibiotics are stopped once | | | | bodies should devise means and programmes to |
| the symptomatic cure has been achieved although | | | | monitor, evaluate, control, and prevent |
| the duration for taking the antibiotic course had to | | | | hospital-based infections, while providing training |
| be in accordance with the attainment of proven | | | | and consultation for medical personnel on the |
| bacteriological cure. The persisting microbes once | | | | appropriate and safe use of antibiotics. As |
| survive the onslaught of medications mutate and | | | | antibiotic resistance knows no national boundaries, |
| acquire resistance to all the drugs of that | | | | they should link up and cooperate with their |
| particular class making the treatment on | | | | counterparts, agencies and NGOs at home and |
| recurrence very difficult. | | | | abroad mutual in surveillance, research and training. |
| Similar results have been seen in studies published | | | | Infectious disease specialists are hoping that new |
| from SKIMS Soura, where resistance to one of | | | | attention to the problem will lead to changes that |
| the most potent class of antibiotics, called fourth | | | | slow the inevitable rise of resistance. The general |
| generation Cephalosporins has been noticed to be | | | | prescription for controlling the problem includes |
| on rise. That means in near future, the use of | | | | changes in medical behavior to protect the power |
| Vancomycin, Linezolid, Quinopristin, drugs that | | | | of existing anti-microbial weapons, increased |
| happen to our last resort against the invading | | | | research to find new killers for the little infectious |
| microbes might have to used as first-line regimen, | | | | killers, and reductions in non-medical uses. |