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Thursday, November 12, 2015

Please do not prescribe/ sell/ purchase or consume antibiotics without appropriate reason



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
complex, any single antibiotic can also confer resistance to antibacterial drugs other than itself. This phenomenon is quite well known and is called cross-resistance.Although cross-resistance has been observed for almost four decades, in individual cases where one drug was tested against another, recent developments in technology have provided a platform to exponentially increase the scale at which these studies can be conducted. Using large scale experiments, recent studies (http://mta.hu/news_and_views/new-results-from-momentum-researchers-in-the-description-of-pathogens-resistant-to-antibiotics-134830/ ) have provided a proof of concept that many clinically important antibiotics have varying degrees of cross resistance to more than one antibiotic.
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.