Bismillah,
This is something that I wrote for the World Pharmacist Day last year. I was quite reluctant to accept the task at first, but then I thought I actually have a message to convey. I was given 2 weeks to complete this. It wasn't easy. I watched documentaries and read articles to find what I needed to focus on. And I had the help from my best friends from various fields to read my article to ensure that my language was as layman as possible. I might have sent them more than 5 edited versions hahaha
Here goes
Little do people know that the dreary-looking pills that they are repeatedly reminded to finish are more than meets the eye. Maybe it is the unpleasant experiences with antibiotics that demotivate ones complaisance to the health care personnel’s advice; the stench that it gives to body fluids, the huge size that makes it hard to swallow down the throat and the metallic taste that it leaves on the tongue are among others. Thus, amidst an antibiotic course, when aching muscles went away and when sleepless nights with fever and cough were gone, the remaining medications are then placed inside the drawer, perhaps useful for another day when we are feeling a bit under the weather. In contrary to this common belief, one might actually pay dearly from discontinuing antibiotics ahead of time.
Coexisting with illness-causing microorganisms have longed been a struggle for humankind. In the ancient world, a technique known as ‘Bloodletting’ was introduced to alleviate ailments due to infection. This method requires a certain amount of blood to be withdrawn from the patient in order to keep body fluids in perfect balance to preserve health. Centuries later, naturally occurring chemicals and compounds started to be utilized to treat infections. However, nowadays these compounds are mostly identified as poisonous and no longer used for treatment; Mercury compounds were widely used to treat syphilis from the 12th until the 18th century. One of the less harmful and painless method in combating infection before the antibiotic era was in treating Tuberculosis. Interestingly, in 1930s patients with Tuberculosis were prescribed with ‘fresh air’ treatment.
What Sir Alexander Fleming found on his disorganized workbench upon his return from summer vacation in 1928 was the stepping stone that revolutionized the management of infection. He found the mold that contaminated his petri dish had prevented the growth of bacteria called Staphylococci. From that day onward began series of isolation of active components and purification that later led to the emergence of the first antibiotic, Penicillin. Thereafter, more groups of antibiotics with different mechanism of actions have been introduced and finally human had the upper hand in the war against bacteria. Not only does antibiotics simplified the management of infections, the improvement in survival rates in previously lethal infections rose exponentially. Moreover, antibiotic has made medical advances such as organ transplant and chemotherapy possible.
Antibiotics work by killing the bacteria or stopping them from multiplying. Additionally, antibiotics assist the natural immune system to take its course in fighting the bacterial infection. Antibiotics that affect a wide range of bacteria are called broad spectrum antibiotics while those that affect only a few types are called narrow spectrum antibiotics. When an antibiotic is prescribed, the dose and length of the course is the amount required to effectively kill all of the disease-causing bacteria. This was determined by solid evidence through many years of research. But unlike treating diseases like hypertension, diabetes and high cholesterol, treating infection is essentially dealing with something that fights back.
In the world of the unseen, the clash between antibiotics and bacteria simulate the battle between the Spartan and the Trojan. When the antibiotic attack, active annihilation of bacteria occurs and if this assault continues uninterrupted, all of the targeted enemies will be exterminated. However, if the offense by the antibiotic is half done, the population that manage to outlive the attack will devise ways to survive future attacks. Bacteria naturally being the master of evolution will learn ways to neutralize the antibiotic army. This new fortified troops of bacteria will rapidly reproduce itself to replace the population that have been killed. When the population expand to a large enough number, they will again cause illness. And for this time around, the antibiotic that was once used to treat the infection will no longer be useful because this new batch of bacteria are already resistant to the antibiotic. As a resort, the use of stronger alternatives that might as well be more toxic is needed.
Over 70 years ago, Fleming predicted that antibiotics will become less effective over time due to careless use. He said, “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 under-dose himself and by exposing his microbes to non-lethal quantities of the drug make them resistant.” Following the golden age of antibiotics when it was hailed as a ‘miracle drug’, its use from merely treating infection in human expand to agriculture. The use of antibiotics were not well regulated in the past and this had led to inappropriate prescribing and extensive use in agriculture. The over usage of antibiotics persists for decades and today the world is facing an alarming crisis that we are heading towards a post-antibiotic era in which common infections and minor injuries can once again kill.
In recent years, there are arising numbers of death due to untreatable infections worldwide. What is more pressing is the emergence of bacteria that are resistant to multiple commonly used antibiotics thus coined as ‘Superbug’. One of the case that captured global attention was in 2011, the story of David Ricci who was out in Kolkata for volunteer work. One fateful morning, while on his way to an orphanage he was dragged by a train and this cost him his right leg. But the worse, his wound was infected by four types of highly resistant bacteria. This was followed by multiple hospitalizations and emergency surgeries because new abscess keep on appearing at the wound site. In 2016, a hospital in China reported a fatal outbreak that took 5 lives. The doctors detected a type of pneumonia that is both highly drug-resistant and deadly. Has antibiotics truly lost its wonder?
Unfortunately, antibiotic resistant bacteria are not limited to health care settings but also lurk in our environment. Use of antibiotics in farms caused the animals to borne resistant bacteria thus the public might be exposed through the meat and animal products. In some developing countries where antibiotics regulation is still less stringent, antibiotics are sold in unauthorized shops and even by hawkers on the streets. These sellers might be selling a less potent drug due to improper storage condition and the imprudent antibiotics disposal done by these illegal sellers subsequently give rise to resistant bacteria in the environment. Furthermore, the increase in international travel pose the risk of spread from one country to another.
Bacteria are catching up faster than the development of antibiotic itself. The development of new antibiotics is declining but more and more resistant bacteria are identified. Bacterial resistance is a natural phenomenon whereby bacteria adapt to threats to stay alive thus stopping it entirely is almost impossible but slowing it down might be our best option.
Fundamentally, the world urgently needs to improve on the way it uses antibiotics. Among the initiatives that have been implemented to help curb antibiotic resistance in hospitals is the Antibiotic Stewardship Program. It is a coordinated program to promote appropriate antibiotic use among prescribers that aims to improve patient outcomes, reduce antibiotic resistance as well as stop spreading of infection caused by drug-resistant bacteria. The team is led by a physician that is trained in infectious disease, co-led by a pharmacist and also involves laboratory staffs that guides on proper use of test and flow of results.
Although there are certain group of people with greater risk than others, no one can completely avoid the risk of antibiotic-resistant infections. However there are steps that can be taken at individual level to reduce the impact and spread of resistance.
· Only use antibiotics when prescribed by a certified health professional
· Always follow your health worker’s advice when using antibiotics
· Never share or use leftover antibiotics
· Prevent infections regularly by washing hands, preparing food hygienically, practicing safer sex and keeping vaccinations up to date.
Lastly, before saving those dreary-looking pills for future ailments, think again whether this is a wise thing to do. Till the day comes when another ‘Odysseus’ is enlightened with brilliant strategies to fend off our micro-sized enemy, our role is to collectively change our behaviours in order to control antibiotic resistance and prevent its spread.
