Antibiotics: Use or abuse?

A recent study conducted by the BYL Nair Charitable Hospital of the BMC in collaboration with the World Heath Organisation has shown that resistance to antibiotics is growing alarmingly in the community residing in the central Mumbai area. The report confirms the growing alarm in the medical profession to the rising spectre of ‘antibiotic resistance’ — a phenomenon in which common germs that cause diseases like diarrhoea, urinary infection, typhoid and TB refuse to be controlled and/or get exterminated when confronted with antibiotics.

The phenomenon has serious ramifications for consumers at large. People who suffer from the diseases mentioned above could face dire consequences, including death, if the infection were to carry on unabated. Hospital beds and clinical facilities would be under stress if faced with the need to test every one with an infection. To a community already screaming about the burgeoning costs of medicare, this will add to the burden of increased hospitalisation, investigations and costlier higher-grade antibiotics to treat what were believed to be easily curable diseases. The occurrence of Multi-Drug Resistant Tuberculosis is an example of this conundrum, as several have succumbed to the disease which was believed to be on the verge of extermination.

Several causes have been cited for the rise in the resistance of bacteria to antibiotics. One common element is the gross abuse of antibiotics at every stage of its use in the community. Patients who approach doctors have no time to waste and insist upon their physicians to prescribe ‘the strongest possible medicine’ so that they can go back to their normal duties the very next day. Acting under this pressure and in gross violation of scientific norms, doctors then prescribe the `strongest’ antibiotic, unaware or indifferent to the fact that the antibiotic may or may not be useful for the condition which the patient suffers from. For example, it has been proved beyond all reasonable doubt that most coughs and colds occur due to viruses, which never respond to antibiotic therapy. Similarly, diarrhoea in children almost always never calls for an antibiotic.
Inspite of this, a very large percentage of persons with these diseases are routinely subjected to antibiotic therapy, where the side-effects of the antibiotics manifest themselves, but there is not the remotest improvement of the patient’s condition because of the antibiotic.

A further aggravating factor in antibiotic misuse is the rampant dispensing of antibiotics by chemists directly to patients who report to them with various illnesses. Clearly and unambiguously against the law, with an inefficient enforcing mechanism in place, such indiscriminate acts are never checked. Patients aggravate this situation by resorting to self-medication. A previous prescription for a similar set of symptoms, or medicines left over from a previous ailment lead to irrational intake of antibiotics which cause further damage to the system.

The problem with antibiotic abuse is that when used indiscriminately, antibiotics are set loose into the environment, giving bacteria a chance to their exposure in `bacteria friendly’ atmospheres. Following the principle of survival of the fittest, bacteria then learn to detoxify these antibiotics by various systems of self-defence. The result: when a patient gets afflicted by a disease which the bacteria causes, the antibiotic is literally `useless’ – which may often be detected after a prolonged period of its use leading to greater adverse effects of the disease on the human body, and ultimately leading to the use of stronger and more costly antibiotics.

Bacteria are nullifying the effects and efficacy of antibiotics at a rate faster than the world is producing newer antibiotics to which these bacteria are susceptible. A day may not be far when no antibiotic will work.