Silent Pandemic of Antibiotic Resistance

Antibiotics have been around for almost a hundred years, and as expected, we turn to them as we face life-threatening infections in attempts to curb death rates. With time, the emergence of viruses led to the arrival of antivirals, as did anti-fungal agents when fungi became prevalent.  No doubt, medicine has faced challenging hurdles with groundbreaking discoveries in the last century. However, there is a meandering threat of bacterial resistance to antibiotics that seems to outpace the advent of newer drugs. In other words, the chances are that a few years from now, when a patient presents to the hospital with a severe infection, there may not be an appropriate drug in the market that can eradicate the infection. Yes, there is a raging antibiotic resistance crisis. This article discusses how this is relevant to the general public and how we can overcome this.

Principles of Antibiotic therapy: Empiric therapy Vs Definitive therapy

Antibiotic therapy should be guided by the identification of the causative organism. For example, you are suspected of having meningitis (infection of the protective membranes of the brain and spinal cord), your doctor has to find out exactly which bacterium is responsible and prescribe an antibiotic that specifically kills that bacterium. This is known as definitive therapy. However, labs require 48-72 hours to produce accurate reports. Until then, your doctor would have to use antibiotics against the most likely organisms. This is known as empiric therapy. Empiric is ideally followed by definitive therapy, especially in serious infections. This is the correct way to use antibiotics when necessary.

What is resistance?

Antibiotic susceptibility is when a particular drug can kill a bacteria. Resistance is when the bacteria can defeat the antibiotic such that the drug can’t eradicate the infection anymore. Antibiotic resistance was reported as early as the late 70s, but evidence shows it was never as alarming as it has been since 2015. Unfortunately, this has not been balanced by the development of newer effective antibiotics.

How does antibiotic resistance occur?

The most common cause of antibiotic resistance worldwide is Overuse/inappropriate use.

A perfect example in our setting is someone rushing to a nearby medicine shop asking the pharmacist for an antibiotic for a sore throat that is likely a viral infection. (Antibiotics don’t kill viruses!) This action is, in fact, the very first step that will lead to the downward spiral that is drug resistance.

There are different types of bacteria in the surrounding, some more potent than others. Some are sensitive to antibiotics, while others may be resistant. When a person unnecessarily uses antibiotics, the more sensitive bacteria die out. At the same time, the more potent, resistant forms are left alone, with no other forms of bacteria that would otherwise compete for nutrients in the host environment. In the absence of competition from other bacteria, the resistant species can now thrive without inhibition. When these bacteria multiply in large numbers without inhibition, they are more likely to undergo mutation, which leads to newer forms of bacteria that are more difficult and possibly impossible to treat.

In addition, not only is that individual at risk of a more serious infection now, he /she also carries a greater risk of spreading the infection in the community. And in today’s world of trade and travel, it’s certainly very quick.

What is the impact of antibiotic resistance?

Antibiotic resistance is a global phenomenon, and the significant impact is on Health and Economy. It has led to greater health care costs (more expensive treatment, extended hospital stay, more frequent hospital visits), longer recovery time, a greater disease burden in the community, and a rise in mortality (deaths) from notoriously antibiotic-resistant bacteria.

Antibiotic stewardship: a possible solution?

The appropriate use of antibiotics is known as antibiotic stewardship. This involves a combination of regulatory policies in antibiotic distribution, prescription, and surveillance to minimize overuse, abuse, and development of resistance.  Along with educating health professionals, it is equally vital for the public to be aware of this as it is a major intervention to preserve decrease antibiotic resistance and its implications.

Role of the public in alleviating this crisis

  • Taking antibiotics wisely- If you think you have an infection, use appropriate antibiotics as prescribed by your doctor. If you have been prescribed an antibiotic, complete the entire course of the drug.
  • Do not buy your antibiotics over the counter. Do not take antibiotics prescribed for another person. Do not take leftover antibiotics.
  • Infection control measures – Immunization, safe food preparation, good hand hygiene (handwashing) are measures that can help prevent infections that require antibiotics.

Author Description:

Dr. Akriti Acharya is an MBBS graduate from Nepal Medical College, and Dr. Anirudra Devkota is an MBBS graduate from Gandaki Medical College. Both of them are currently working as Medical Officers.


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