Cross-Resistance: An overlooked threat beyond direct antibiotic resistance
Gopal Gunanathan Jayaraj & Dr. A.J. Tamhankar
We
are already at the brink of a post-antibiotic era where very soon even the most
advanced fifth generation antibiotics like cephalosporins will fail to work
against common infectious agents (http://www.nature.com/news/who-warns-against-post-antibiotic-era-1.15135
). Current estimates by the WHO and CDDEP indicate that countries like India
and China run the greatest risk of losing out on the utility of our antibiotic
arsenal against infectious agents (https://www.newscientist.com/article/dn28180-global-study-reveals-soaring-antibiotic-resistance-in-india/
). This risk is even more pronounced in India where a combination of
unrestricted access, rampant overuse and general lack of awareness dominates
the burden on healthcare.
It
is a commonplace practice in India where people from lower socio-economic
strata or sometimes even from the upper socio-economic strata from both urban
and rural areas avoid going to the doctor and procure “medicines” directly from
the pharmacist without a diagnosis. For example a person having a fever and cough/running
nose is supplied with antibiotics like Ciproflox/Gatiflox 400 or Erythromycin 500
along with Crocin/Paracetamol, ( “medicines” for the consumer) by the
pharmacist – as a common medication for the patient`s complaint. However in
most cases, the symptoms may be due to a viral infection and thus cannot be
treated at all with antibiotics like Ciproflox/Gatiflox 400 or Erythromycin500.
For a person having a fever of viral origin, the paracetamol would help subside
the fever and the cough/running nose will be over in most cases in a short
period of time, being self limiting. However, the unnecessary consumption of Ciproflox/Gatiflox
400 or Erythromycin 500 does something far more dangerous. Being unnecessarily
taken, it would expose resident bacteria (we carry several types of bacteria in
our body systems, which do not cause any harm) that are not causing the symptom,
i.e. cough/running nose and fever, and the consumption of antibiotic without
any need, would expose them to antibiotics and leave behind bacteria in which antibiotic
resistance has been initiated.
A
very simplistic explanation of how antibiotic resistance arises can be summed
by the quote “What does not kill something makes it stronger (by just the experiencing it)” by
Friedrich Nietzche, which means in our current case that, improper and
incomplete usage of antibiotics leads to surviving microbes becoming resistant
to that given drug. However this is a very one-dimensional view where our
understanding centers on ‘use of single drug imparting resistance to the same
drug’. The reality of the situation is however far more
This
is particularly hazardous in India, where there is no or little restriction on
over-the-counter purchase of any antibiotic without a prescription (as
illustrated in the example earlier). To be more specific, the person who
consumed Ciproflox/Gatiflox 400 or Erythromycin500 for cough/running nose and
fever in the example cited in an earlier paragraph earlier, may, after unnecessary
consumption of these drugs, harbor bacteria, which are not only resistant to Ciproflox/Gatiflox or Erythromycin, but also to Doxycycline as
well, which is a different type of antibiotic. And we have taken Doxycycline
only as an example here, in real life scenario, the unnecessary consumption of
antibiotics can result in the spread of resistance to many other antibiotics.
So
please do not prescribe/ sell/ purchase/consume antibiotics without appropriate
reason.
