Increasing drug resistance is limiting the options to treat infections- Moving back towards pre-antibiotic era?

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Increasing drug resistance is limiting the options to treat infections- Moving back towards pre-antibiotic era?

Professor Dr.  Saeed Khan, Department of Pathology, Dow International Medical College,  Dow University of Health Sciences,,

When the most groundbreaking discoveries of the 20th century are discussed, it is unanimously agreed upon to consider antibiotics as being one of them. A Scottish scientist named Alexander Fleming introduced us to this miracle at St. Mary’s Hospital in London right after the First World War. It was 1928 and Penicillin was now known as the first discovered Antibiotic. The irrefutable effect of this new discovery and its accessibility was seen when mortality due to infectious diseases significantly went down. The field of medicine and its practitioners now maneuvered differently and much more effectively when it came to treating life-threatening communicable diseases. By 1945 however, Fleming was already delivering lectures issuing warnings regarding the great threat of antimicrobial resistance. He declared, “The time may come when penicillin can be bought by anyone in the shops. Then there is the danger that the ignorant man may easily underdoes himself and by exposing his microbes to non-lethal quantities of the drug make them resistant”. The medical community saw this statement turn into reality when the first Methicillin-Resistant Staphylococcus Aureus (MRSA) bacterium was identified only 2 years after methicillin was introduced. We have seen this trend continue as we observe the rise of antimicrobial resistance in the environment, hospitals and various communities worldwide. This development of resistance can be credited to the overuse and frequent prescription of antibiotics as well as a severe lack of due pharmaco-vigilance. Multiple studies have gone on to show how such practices lead to a rapid emergence of resistance in the bacteria.

In order to make sense of why this occurs, we first need to take into account the living status of these microbes. These organisms not only are alive but they also multiply continuously. Some are harmless bacteria present as normal flora on human skin and help sustain environmental balance, feed plants, breakdown organic garbage, ferment food all while protecting us from “bad” bacteria. However, practices of superabundant use of antibacterial soaps as well as hand sanitizers have been detrimental to these “good” bacteria. This injury to the normal flora leads to opportunistic bacteria taking over which come with their pre-developed resistance to the available antibiotics. No governmentally authorized bodies have been recognized in countries where antibiotic resistance is taking a strong foothold. Similarly, no rules and regulations are in place for buying these drugs over the counter without prescription. Such scarcity of legislation has led to these antibiotics becoming freely available to the point that they are sold at cheaper prices and can be bought online as well. Another precipitating factor for this swift rise in antibiotic resistance is the lack of development and experimentation on new drugs by pharmaceutical companies. Myriads of challenges as well as economic crises are the reasons behind this shift.  Hence, even though it is the 21st century, the human race continues to take the brunt of infectious diseases all while new variants of these diseases due to development of resistant strains continue to come to light. This also puts animal health in a precarious position. Such patterns of diseases negatively impact healthcare services along with the costs of treatment and management of these illnesses. This causes mortality rates to go up and due to improper treatment, hospital stays are prolonged. These facts and figures provide us with the clue that Anti-Microbial Resistance (AMR) is not just a predicament for medical services but that its burden is shared by almost all sectors of health and society in general.

The issue of “Antibiotic Resistance” was addressed in the agenda of UN General Assembly meeting conducted in 2016. The primary objective of the meeting was to maintain a strong national, regional as well as international political commitment in order to address this issue. It was decided that comprehensive action must be taken ranging over all sectors that either play a part or are affected while awareness is provided to the masses regarding this increment in antimicrobial resistance. World Health Assembly Resolution WHA 68.7 entitled “Global Action Plan on antimicrobial resistance” reflects a global consensus that antimicrobial resistance is a major challenge to public health and emphasizes the significance of achieving the five strategic objectives of the WHA Global Action Plan. 700,000 deaths might be caused on a global scale due to AMR and if the resistance rate is increased even by just 40%, up to 9.5 million people may die each year. These estimates were declared in 2016 in a report by the Organization for Economic Co-operation and Development (OECD).

For the past few decades, Pakistan has observed a rise in its population and with that came an increment in some major health issues as well. Infectious diseases are a considerable part of these health issues and affect not only the human population but also put the country’s livestock at risk. It was reported by Pakistan Medical Association that there are over 600,000 non-registered medical practitioners in the country who believe antibiotics to be the treatment of all kinds of diseases which has given rise to AMR in the country. However, in a country like Pakistan, we have no updates in the documentation of AMR and substantial data is lacking. Multidrug resistant tuberculosis and typhoid have emerged and it is close to impossible to assign any definitive mode of treatment for these diseases. Hospital acquired infections are also on the rise and with the development of resistance in the microbes the elimination of these could become very tough for health care professionals.

As medical professionals, we must become more responsible with the prescriptions of antibiotics since only certain conditions demand their use even though they come with a strenuous list of side effects. This vigilant attitude towards dealing with this issue can be aided by implementing the National Action Plan for Combating Antibiotic Resistant Bacteria devised back in 2015. Some of the major objectives of this plan were to decelerate the emergence of these resistant strains and preventions of spread of resistant infections all while measures are undertaken in order to strengthen National One-Health Surveillance Efforts to combat this resistance. An advancement in development as well as employment of some newer diagnostic methods for identification and flagging of these resistance strains could help as well along with more efforts being made to develop new Antibiotics and Vaccines via well-funded research. In the end, international collaborative actions could help the scientific community deal with this issue as well as provide better surveillance and developmental research opportunities. A return to the pre-antibiotic era might be anticipated if such actions are not taken promptly, an era where no cure or drugs were there for eliminating these pathogens and treating infectious diseases.