The estimates show us that by the year 2050, antibiotic resistance would kill 10 million people annually as compared to 8.2 million deaths by cancer and 1.2 million deaths by diabetes.
As of today, more than 700,000 people die globally due to antibiotic resistance, whereas in India the estimate is more than 300,000 deaths every year. The emergence of antibiotic resistance is mainly due to misuse or overuse of antibiotics which are normally used to treat infections (discussed later).
Each individual on an average is colonized with between 10-100 trillion microbes (primarily bacteria) which contribute to 1-3% of the total body weight of a person, in what is known as human microbiota.
Majority of these bacteria (500-100 types) reside inside the human gut to form “normal gut flora”. The composition is determined by the diet, exercise, diseases conditions and overall health changes in an individual.
It is scientifically proven that the composition of microbiota determines the disease states like obesity and the outcome of the infectious diseases.
However, the gut is colonized by both pathogenic (disease-causing) as well as commensal (beneficial) bacteria. In the normal state, the commensal bacteria outnumber the pathogenic ones and hence limit their activity.
Under conditions (dietary changes, stress, disease and or injury) where normal flora is perturbed, pathogenic strains will emerge. One of the major contributing factors toward the rise of these pathogenic strains is due to the use of an antibiotic, which eventually leads to antibiotic resistance.
What is antibiotic resistance?
Antibiotic resistance is the ability of pathogenic bacteria to grow in the presence of an antibiotic that would normally kill them or limit their infectious activity. These resistant bacteria make it harder to eliminate infections from the body as existing drugs become less effective.
Normally antibiotics are used to treat infections, but these drugs cannot differentiate between good and bad bacteria and hence indiscriminately remove all the microbes from the gut.
This results in an imbalance in the normal gut flora and eventually the dominance of the pathogenic strains which may exacerbate the disease state.
Though normally individuals do not immediately end up with resistant bacteria, the continuous misuse and overuse of these drugs may pose the threat.
One of the recent examples is the emergence of multidrug-resistant (MDR) and extensively drug resistant (XDR) Mycobacterium tuberculosis (TB), against which most of the drugs are ineffective.
India has witnessed its first multi-drug resistant (superbug) in the year 2008 when a new anti-bacterial resistant strain was discovered, named as New Delhi metallo-beta-lactamase 1 (NDM1), against which most of the antibiotics are ineffective (Lancet, 2008).
Besides, India is the largest consumer of antibiotics in the world, and scientific reports suggest a steep rise in the emergence of new resistant bacteria.
A recent study from Sher-e-Kashmir Institute of Medical Sciences has found that patients with Helicobacter pylori (linked to bad breath) infection have developed resistance to most of the available drugs, sparing tetracyclines (Wani FA et al, 2018).
Although the sample size was limited, this pilot study shows us that this part of the world is also developing antibiotic resistance and at a faster rate.
Over the years, an increasing trend has been seen in the emergence of more antibiotic-resistant bacteria, many of which have already turned into superbugs (12, as per the WHO report).
Currently, there is no single antibiotic which has escaped the wrath of the bacterial defense mechanism. A few years back, carbapenems were considered to possess the broadest spectrum of activity and high potency.
These drugs were and are often used as “last-line agents” in patients with grave and untreatable infections who have developed resistance against other forms of antibiotics.
Unfortunately, the emergence of carbapenem-resistant bacteria (these bacteria make an enzyme; carbapenemases which degrade the antibiotic) has elicited a worldwide threat to antimicrobial therapy. The challenges posed to the use of “this last resort of antibiotics” has startled the medical community to develop alternative treatment regimen.
However, as of now, none of the new antibiotics in development are expected to show efficacy against multi-drug resistance. Additionally, drug discovery is a time-consuming process, and even if some success is met, microbes will find ways to overcome their effects.
What are the causes of antibiotic resistance?
Use of antibiotics: Antibiotic use is the major cause of antibiotic resistance. Though with a note of precaution, proper use of antibiotics may not be harmful, it is the misuse and overuse of these drugs which is threatening.
With the rising income, easy access, over-the-counter sale and low cost of these antibiotics, the majority of the people use antibiotics without any medical consultation.
This overuse and misuse of antibiotics have resulted in a growing list of life-threatening infections – such as tuberculosis, pneumonia, blood poisoning, gonorrhea (sexually transmitted infection), skin disorders, meningitis, urinary tract infection, and foodborne diseases.
The list is ever increasing and sometimes these conditions are impossible to treat as most of the available antibiotics become less effective or incur resistant against these diseases.
Inadequate health care settings: Improper diagnosis of the disease may lead to wrong prescription and the development of antibiotic resistance.
Further, a growing threat is the unnecessary prescription of antibiotics by non-professional physicians, who indiscriminately prescribe the use of antibiotics even against mild infections.
The reason being doctors routinely receive compensation from the pharmacists and these drug making companies.
Another factor which has substantially contributed to the emergence of pathogenic bacteria is the poor infection control in hospitals.
Majority of the patients undergoing surgical procedures receive antibiotic treatment which may eventually end up with them to develop resistance.
Consumption of antibiotics in the food: Recent studies across the country have found widespread use of antibiotics in milk and dairy products such as chicken, cattle, and fish.
These drugs are used with the intention to combat infection in the livestock, but due to their low biodegradable nature, they get easily carried and accumulated in humans.
This actionable use of antibiotics in the animal sector is driving the emergence of new resistant and highly pathogenic bacteria.
How can we prevent antibiotic resistance?
There is still hope to combat antibiotic resistance provided serious health majors are undertaken at all levels of society and by every individual. Following are some of the majors:
- Only use antibiotics when prescribed by a certified health professional
- Never force your healthcare professional to prescribe antibiotics
- Follow the instructions and advice from the professional when using antibiotics
- Do not stop antibiotics midway, even if you feel better. Complete the course
- Never miss the dose and follow proper instructions
- Take suboptimal dosages (not higher or lower), and as directed
- Choose foods that have been produced without the use of antibiotics
- Spread awareness among your family, friends, and community
Further, without proper medical consultation antibiotics should be avoided for upper respiratory tract infections, diarrhea, cold and other viral infections, against which most of these drugs show very less efficacy or no efficacy at all, but their unnecessary use may result in the emergence of more dreadful pathogens.
Particularly, antibiotics with a red line on their strips are strictly prohibited and should be consumed only after medical prescription by the reliable physician.
What is the individual responsibility?
Physicians may continue to prescribe antibiotics, but it is the responsibility of every individual to question your doctor and to know the exact reason behind the prescription. Following questions should be asked when an antibiotic is prescribed.
- How do you know I need them?
- Is it certain that there is a bacterial Infection?
- What will happen if I let the Infection to run its course and get cured naturally?
- What are the side effects?
- How long do I need to use these antibiotics?
The antibiotic resistance crisis is putting humanity at risk like never before. Public awareness, professional health practice, and strict government policies are in dire need to overcome this deadly condition and to create a salubrious environment for our future generation.
Author is an Assistant Professor, Multidisciplinary Center for Advanced Research and Studies, JamiaMilliaIslamia