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10 January, 2018 11:16:58 AM


Balancing risks of antibiotic resistance

Dr. Mohammed Abul Kalam
Balancing risks of antibiotic resistance

Humans developed antimicrobials to destroy disease-causing microbes. The most commonly known antimicrobials are antibiotics, which target bacteria.  Other forms of antimicrobials are antivirals, antifungals, and antiparasitics.

Antibiotics, also known as antimicrobial drugs fight infections caused by bacteria in both humans and animals. Antibiotics fight these infections either by killing the bacteria or making it difficult for the bacteria to grow and multiply. Antibiotics do not have any effect on viruses. Bacteria are single-celled organisms found all over the inside and outside of our bodies. Many bacteria are not harmful. In fact, some are actually helpful, including the majority of bacteria that live in our intestines (guts). However, disease-causing bacteria can cause illnesses such as strep throat. Viruses, on the other hand, are microbes that are even smaller than bacteria that cannot survive outside the body's cells. They cause illness by invading healthy cells. The term "antibiotic" is originally referred to a natural compound that kills bacteria, such as certain types of mold or chemicals produced by living organisms. Technically, the term "antimicrobial" refers to both natural and synthetic (man-made) compounds; however, many people use the word "antibiotic" to refer to both.
About resistance: Antibiotic / antimicrobial resistance is the ability of microbes to resist the effects of drugs – that is, the germs are not killed, and their growth is not stopped. Although some people are at greater risk than others, no one can completely avoid the risk of antibiotic-resistant infections. Infections with resistant organisms are difficult to treat, requiring costly and sometimes toxic alternatives. Bacteria will inevitably find ways of resisting the antibiotics developed by humans, which is why aggressive action is needed now to keep new resistance from developing and to prevent the resistance that already exists from spreading.

Antibiotic resistance is the ability of bacteria to resist the effects of an antibiotic. Antibiotic resistance occurs when bacteria change in a way that reduces the effectiveness of drugs, chemicals, or other agents designed to cure or prevent infections. The bacteria survive and continue to multiply, causing more harm. Antibiotic resistance has been called one of the world's most pressing public health problems. Antibiotic resistance can cause illnesses that were once easily treatable with antibiotics to become dangerous infections, prolonging suffering for children and adults. Antibiotic-resistant bacteria can spread to family members, schoolmates, and co-workers, and may threaten your community. Antibiotic-resistant bacteria are often more difficult to kill and more expensive to treat. In some cases, the antibiotic-resistant infections can lead to serious disability or even death.

Although some people think a person becomes resistant to specific drugs, it is the bacteria, not the person, that become resistant to the drugs. Overuse and misuse of antibiotics can promote the development of antibiotic-resistant bacteria. Every time a person takes antibiotics, sensitive bacteria (bacteria that antibiotics can still attack) are killed, but resistant bacteria are left to grow and multiply. This is how repeated use of antibiotics can increase the number of drug-resistant bacteria.

Antibiotics are not effective against viral infections like the common cold, flu, most sore throats, bronchitis, and many sinus and ear infections. Widespread use of antibiotics for these illnesses is an example of how overuse of antibiotics can promote the spread of antibiotic resistance. Smart use of antibiotics is the key to controlling the spread of resistance.

Bacteria can become resistant to antibiotics through several ways. Some bacteria can “neutralise” an antibiotic by changing it in a way that makes it harmless. Others have learned how to pump an antibiotic back outside of the bacteria before it can do any harm. Some bacteria can change their outer structure so the antibiotic has no way to attach to the bacteria it is designed to kill.

After being exposed to antibiotics, sometimes one of the bacteria can survive because it found a way to resist the antibiotic. If even one bacterium becomes resistant to antibiotics, it can then multiply and replace all the bacteria that were killed off. That means that exposure to antibiotics provides selective pressure making the surviving bacteria more likely to be resistant. Bacteria can also become resistant through mutation of their genetic material.

Explanation of bacteria and other microbes: Microbes are organisms too small for the eye to see and are found everywhere on Earth.  There are many types of microbes: bacteria, viruses, fungi, and parasites.  While most microbes are harmless and even beneficial to living organisms, some can cause disease among humans, other animals, and plants.  These disease-causing microbes are called pathogens; sometimes they are referred to as “germs” or “bugs.”  All types of microbes have the ability to develop resistance to the drugs created to destroy them, becoming drug-resistant organisms.

How resistance happens and spreads: The use of antibiotics is the single most important factor leading to antibiotic resistance around the world.  Simply using antibiotics creates resistance.  These drugs should only be used to manage infections.

Trends in drug resistance: Antibiotics are among the most commonly prescribed drugs used in human medicine and can be lifesaving.  However, up to 50 per cent of the time antibiotics are not optimally prescribed, often done so when not needed, incorrect dosing or duration. The germs that contaminate food can become resistant because of the use of antibiotics in people and in food animals.  For some germs, like the bacteria Salmonella and Campylobacter, it is primarily the use of antibiotics in food animals that increases resistance.  Because of the link between antibiotic use in food-producing animals and the occurrence of antibiotic-resistant infections in humans, antibiotics that are medically important to treating infections in humans should be used in food-producing animals. This should be done only under veterinary supervision and only to manage and treat infectious disease, not to promote growth. The other major factor in the growth of antibiotic resistance is spread of the resistant strains of bacteria from person to person, or from the non-human sources in the environment.

Viral infections should not be treated with antibiotics. Common infections caused by viruses include colds, flu, most sore throats, most coughs and bronchitis (“chest colds”), many sinus infections, and many ear infections.

Here is what you can do to help prevent antibiotic resistance. Tell your healthcare professional you are concerned about antibiotic resistance and ask if there are steps you can take to feel better and get symptomatic relief without using antibiotics.  Take the prescribed antibiotic exactly as your healthcare professional tells you and discard any leftover medication. Ask your healthcare professional about vaccines recommended for you and our family to prevent infections that may require an antibiotic. Never skip doses or stop taking an antibiotic early unless your healthcare professional tells you to do so and never take an antibiotic for a viral infection like a cold or the flu. It is unwise to pressure your healthcare professional to prescribe an antibiotic and never save antibiotics for the next time you get sick. Lastly, never take antibiotics prescribed for someone else.

Healthcare professionals can prevent the spread of antibiotic resistance by prescribing an antibiotic only when it is likely to benefit the patient; Prescribing an antibiotic that targets the bacteria that is most likely causing their patient’s illness when an antibiotic is likely to provide benefit; Encouraging patients to use the antibiotic as instructed; Collaborating with each other, office staff, and patients to promote appropriate antibiotic use. Avoid treating viral syndromes with antibiotics, even when patients ask for them; Doctors should pay attention to dose and duration. The right antibiotic needs to be prescribed at the right dose for the right duration. Be aware of the antibiotic-resistance patterns in your area so that you can always choose the right antibiotic. Hospital and nursing home providers should reassess within 48 hours of starting the antibiotic, when the patient’s culture results come back. Adjust the prescription, if necessary and stop the prescription, if indicated. Healthcare professionals should also educate patients about appropriate use of antibiotics, include microbiology cultures, when possible, when ordering antibiotics and work with pharmacists to ensure appropriate antibiotic use and prevent resistance and adverse events. Following hand hygiene and other infection control measures with every patient is a necessity and so is embracing antibiotic stewardship. It is important to improve antibiotic use in all facilities—regardless of size—through stewardship interventions and programs, which will improve individual patient outcomes, reduce the overall burden of antibiotic resistance, and save healthcare money.

The increasing prevalence of antibiotic resistance has led to the use of more expensive and broad-spectrum antibiotics for empiric treatment of common outpatient infections, and increased morbidity and mortality among patients hospitalised with serious community-acquired infections.

Reducing inappropriate use of antibiotics is a critical step in slowing the progression of current levels of resistance, and in preventing the emergence of new strains of antibiotic-resistant bacteria. Accomplishing this requires a two-part approach. First, the use of antibiotics in conditions for which these drugs provide little or no benefit must be reduced. Second, antibiotics prescribed for patients who do require antimicrobial therapy must be appropriately targeted, and inappropriately lengthy treatment courses should be shortened.

Penicillin, the first commercialised antibiotic, was discovered in 1928 by Alexander Fleming.  While it wasn’t distributed among the general public until 1945, it was widely used in World War II for surgical and wound infections among the Allied Forces.  It was hailed as a “miracle drug” and a future free of infectious diseases was considered.  When Fleming won the Nobel Prize for his discovery, he warned of bacteria becoming resistant to penicillin in his acceptance speech.

The writer is Former Head, Department of Medical Sociology

Institute of Epidemiology, Disease Control & Research (IEDCR)

Dhaka, Bangladesh



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Editor : M. Shamsur Rahman
Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
Editorial, News & Commercial Offices : Beximco Media Complex, 149-150 Tejgaon I/A, Dhaka-1208, Bangladesh. GPO Box No. 934, Dhaka-1000.

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