Anti-Microbial Resistance: A Threat to Medical Sciences

 

Modern science has advanced to a level that we are more than confident that there is not a single disease that can’t be conquered. Curing disease like Diarrhoea, Malaria sounds like a thing of past and are regarded as a cinch. Wait! I doesn’t indent to sound like a devil’s advocate but here is something new that you must hear out.

Scientists has been witnessing change in the behaviour of bacteria and parasites when they are treated with those mighty drugs. In short, the drugs are no more effective. Those microbe has started to adapt and mutate to fight against your regular drugs. Well this is not a hidden phenomenon which I claim to be a new discovery. WHO – World Health Organisation – has accepted it as ‘global health and development threat’[1]. This phenomenon is termed as ‘Anti Microbial Resistance (AMR)’.

To understand AMR, first you must know what anti-microbial is. These are those medicines – antibiotics, antiviral, antifungal – which were used to treat infections in human, animals and plants.

According to Centre of disease control, USA, Antimicrobial Resistance ‘happens when germs like bacteria and fungi develop the ability to defeat the drugs designed to kill them. That means the germs are not killed and continue to grow’[2].

On one hand the AMR menace is rising, on the other, the clinical pipeline of new antimicrobial is dry. The main reason for this being the complacent attitude of scientist community to bring innovation in the field where the treatments are already working in a sound manner. This is going to inflict a serious cost the any nation’s economy because of the burden of prolonged stays at hospital and the need for more expensive and intensive care.

So the question that arises in an inquisitive mind is what causes it ? According to National Institute for Allergy and Infectious Diseases, the causes are multifaceted ranging from natural to societal causes. In the presence of an antimicrobial, microbes are either killed or, if they carry resistance genes, survive. These survivors will replicate, and their progeny will quickly become the dominant type throughout the microbial population.[3] The replication period of most microbes is only few hours. During the replication, occurrence of mutations is but a natural phenomenon. In words of Herbert Spencer, “Survival of the fittest”. Other reasons may include overuse and misuse of drugs or leaving the treatment in between and wrong diagnosis which is a common occurrence. It has been pointed out by several researchers that the use of antibiotics in agricultural feeds also promotes drug resistance. Lack of awareness of recent developments in medicine science and advertent negligence of pharma manufacturers to produce cheap medicines, along with lack of sanitation, are also major causes of spreading of resistance in third world countries.

The consequences of drug resistances can be far reaching. Firstly, the failure of treatment may lead to chronic problems and result into chronic morbidity or mortality. Excessive healthcare cost and decreased societal productivity may also be an outcome of it. “Antibacterial drugs used to prevent infections after surgeries or to treat common infections in neonatal and intensive care may become less effective or ineffective”, says experts at Biomerieux.

The present situation of AMR can be understood by considering the fact that "for common bacterial infections, including urinary tract infections, sepsis, sexually transmitted infections, and some forms of diarrhoea, high rates of resistance against antibiotics frequently used to treat these infections have been observed world-wide, indicating that we are running out of effective antibiotics. For example, the rate of resistance to ciprofloxacin, an antibiotic commonly used to treat urinary tract infections, varied from 8.4% to 92.9% for Escherichia coli, and from 4.1% to 79.4% for Klebsiella pneumoniae in countries reporting to the Global Antimicrobial Resistance and Use Surveillance System (GLASS)" - WHO. More than 20% cases of tuberculosis has already been converted into multi drug resistant tuberculosis (MDR-TB).

 

The phenomenon like this requires multi-spectral approach. There is an initiative called One Health Approach which is working right in this field. Though the need for greater investment and innovations cannot be negated. On their parts, what doctors should do is to prescribe the antibiotics only when they are necessary. And we, the citizens of this happy world, must strictly follow the advice of doctors.


[1] https://www.who.int/

[2] Centre for Disease Control, USA

[3] National Institute of Allergy and Infectious Disease