INVASION OF THE SUPERBUGS

A threat beyond imagination

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We are all familiar with antibiotics; the medicines we get after a visit to the doctor, the ones that are more expensive than other regular medicines, give you an upset tummy and come along with Vitamin B12 tablets on the side. The doctor also insists on taking them exactly as prescribed and strictly not stopping halfway through the course. Though antibiotics are considered to be one of the most revolutionary discoveries ever, we have to be aware of the danger of antibiotic misuse and its serious consequences.

What are antibiotics?

Simply put, antibiotics are chemical compounds produced by microorganisms to kill or inhibit other microorganisms. These are commonly extracted from the said microbes or synthesised chemically for use against a vast spectrum of infections.

First-line antibiotics are those used regularly since they are economical, easily available, highly effective and with few (if any) side-effects. Second-line antibiotics are expensive, may not be locally available and have a higher risk of severe side effects. Further along the line are third-line antibiotics, which are used only when other drugs fail and have an extremely high risk-to-benefit ratio.

First-line antibiotics have few side effects, most commonly diarrhoea. Since antibiotics work against bacteria, they also end up wiping out the good bacteria that are present in our gut. These good bacteria generally aid in digestion and produce vitamin B12, which is essential for our general health. That is why a course of antibiotics imbalances our gut microflora, leading to the common side effects of nausea, diarrhoea and vitamin B12 deficiency. Second and third-line antibiotics have much severe side effects, sometimes even leading to liver toxicity.

What is antibiotic resistance?

Under ideal conditions, antibiotics kill the target micro-organism effectively, leading to clearing of the infectious disease they cause. However, antibiotics have been used so widely and for such a long time that the organisms which were earlier vulnerable to these antibiotics started to adapt and mutate (make changes in their DNA) such that they can now completely resist the effects of these antibiotics. Such mutations are also passed on by the organisms to the next generation and other non-resistant organisms.

Extensive antibiotic overuse and misuse have now led to a global threat, creating smart antibiotic-resistant organisms. Evolutionary pressure in due course has led to organisms which can thus resist more than one drug (Multi-drug resistant organisms or MDR), a wide spectrum of drugs (Extensively-drug resistant organisms or XDR) or all available antibiotic drugs (Pan-drug resistant organisms or PDR). These are more colloquially called SUPERBUGS.

Drug-resistant organisms thus require the use of second or third-line antibiotics, leading to less effectiveness and higher risks. If drug resistance continues at the rate it is today, we would soon be left with a vast number of resistant bacteria and no drugs to treat them, as is the concern with diseases like Tuberculosis and Staphylococcus infections.

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How can we prevent antibiotic resistance?

The only way to counter antibiotic resistance is to prevent overuse or misuse of antibiotics. Self-medication of antibiotics (especially over-the-counter skin creams and eye drops with antibiotic components) leads to unnecessary use of antibiotics.

Antibiotics act against bacterial or protozoan infections and DO NOT have any effect on viral illnesses (like the common cold and sore throat). These days, it is common practice for doctors to prescribe antibiotics for every sneeze and cough. But it is essential to confirm that antibiotics are only used when bacterial infection is diagnosed, or a secondary bacterial infection is suspected to accompany the primary viral infection.

Another common problem with antibiotic treatment is non-compliance. When patients taking antibiotics stop their course halfway (due to costs, unavailability, side-effects or plain self-diagnosis that one is cured), they may create a pool of bacteria that are not killed in the course but are now capable of mutating against the antibiotic taken. This pool of bacteria now multiplies and spreads, eventually becoming resistant to the antibiotic that was ineffectively used against it.

In 1945, Alexander Fleming (who discovered penicillin, one of the first antibiotics ever) warned about this situation in his Nobel lecture:

“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 underdose himself and by exposing his microbes to non‐lethal quantities of the drug make them resistant. Here is a hypothetical illustration. Mr. X. has a sore throat. He buys some penicillin and gives himself, not enough to kill the streptococci but enough to educate them to resist penicillin. He then infects his wife. Mrs. X gets pneumonia and is treated with penicillin. As the streptococci are now resistant to penicillin the treatment fails. Mrs. X dies. Who is primarily responsible for Mrs. X’s death? Why Mr. X whose negligent use of Penicillin changed the nature of the microbe. Moral: If you use Penicillin, use enough.”

It is high time now to start taking the right steps to stop the spread of superbugs, before we end up in a world just like the world before the discovery of antibiotics!