Antibiotic Resistance from Management Perspective
“The following article has been written to illustrate how the management world works around with respect to the pharmacy world and how the market with been manipulated and drugs are been sold in the market”
“There is a danger that the ignorant man may easily under-dose himself and by exposing his microbes to non-lethal quantities of the drug make them resist”.
(Alexander Fleming 11th Dec 1945)
Some people fearing resistant bacterium may cause epidemic with no treatment available, but actually, the good part is the threat of epidemic will never come to pass. Not at least 65 years of routine antibiotic use have failed to prompt one. But there are lesser problems, the anxiety towards resistance of medicine is there.
There are regions in the world where prescriptions are unnecessary, patients press there doctors to prescribe them antibiotics for meagre infections like cold or influenza. There is a subdivision in the society known as Hypochondriacs* who act as a breeding ground for bacterial resistance that may infect others. Sometimes patients who are correctly prescribed also become a reason for resistance by not completing the course and result guilty. The regions where the prescription is unnecessary, where the antibiotics are bought over there counter with no diagnosis and recommendations which is further resulting in human reactions.
A microbiologist named as Louise Slaughter who also happens to be an American Congresswoman provided stats that in America the antibiotics which have been used, the fourth is used for the livestock. The reason it provides cheaper meat but again provides an opportunity for bugs to breed and evolve resistance.
An era back due to this troublesome kind, new cases of TB were been registered in parts of Russia. A study conducted in Chicago, about 1400 patients were sampled in a hospital where the researchers found a result that 188 had strains of Bacteria Resistant and 12 of them had died because of lack of adequate treatment. At the moment the children, the old, cancer patients and chronically ill are threatened the most. Nearly 450,000 cases are been registered every year for multi-drug resistant tuberculosis. The antibiotic resistance is resulting in medical cost and however, there could be worse to come.
The antibiotic resistance is also resulting in financial costs which are imposing a disproportionate burden on the poor country. Poor countries are not as lucky as America which is rich and can afford. An American think-tank pointed out that resistance often increases the drug bill because the patients are forced to turn from cheap widely used drugs to more expensive alternatives. The poorer the country the larger the share of its health care budget which is been typically absorbed by the cost of drugs.
From the history before penicillin, (before the mid-1940’s) possibility of the death of a perfectly healthy person due to septicemia due to casual everyday cut used to happen and most notably bacterium infections like TB was a routine killer. Worrying about 150,000 TB deaths a year as compared to millions before, antibiotics and vaccines have turned it into Anachronism* and sound like a counsel of perfection. But again restricting the availability of antibiotics in poor countries where obtaining a doctor’s prescription os costly as well as time-consuming, it would again cause people to die who might have lived.
There are fundamental biological causes too for deeming that resistance may be self-limiting. For a bug being resistant is costly. It has to adapt its physiology and resistance which usually works by making enzymes that corrupt the drug, or by generating extra copies of proteins that pump the drug out of the bacterial cells. both of which needs a lot of energy. Some creatures cannot seem to achieve the trick at all at least for some drugs. One species of Streptococcus* called S.Pygenese* has never been seen to throw up a penicillin-resistant strain, whereas another S.Pneumonia* is frequently not susceptible to the drug. In these circumstances the theory goes, a resistant organism is less a super-bug and more a cosseted creature that can heat the competition only in the unfair arena of a hospital.
Unfortunately, this being a comforting argument this may not be wholly true. In the year 2007 Herman Goossens, a microbiologist at the University of Antwerp laid out the results of a trial intended to examine the idea. His team divided healthy volunteers into three groups. To one group they gave ab antibiotic called Azithromycin, to the second group they gave clarithromycin, to the third group they gave a placebo. They then followed the course of the streptococci in each volunteer’s throat. As suspected those who were taking the placebo exhibited no signs of drug-resistant strains of streptococcus at any time during the study. Also as expected, the streptococci in those taking the antibiotics showed distinctly elevated levels of resistance within days. What was surprising and worrying was that for those who think that resistant bacteria will do better than the non-resistant wild-type only while selective pressure remains on-was that those population of streptococci which acquired resistance retained it for over a year.
According to an article by James Hughes of Emory University, in Atlanta, Georgia, which was published in February by the Journal of the American Medical Association, as much as 50% of antibiotic use is unnecessary or inappropriate. Overuse, misuse, improper dosing and the use of substandard or diluted medicines all contribute to the rise resistance, but too weak health-care systems and poor or unenforced regulations. Unless a severe code of practice prevents overuse and systems are in place to watch their behaviour, doctors have every incentive to treat the patient in front of them not worrying about the theoretical patient hence who may suffer from consequences of the overdose of antibiotics.
There are several reasons and one is that early researchers were lucky. As the modern pharmaceutical industry began with the development of aspirin, a drug that has never been bettered for many applications, so penicillin and it is contemplating easily discovered because they have strong effects which are not easy to progress on. An unpredicted second problem is that modern science has failed to help drug manufacturers have poured huge sums into applying Genomics* and Protemics* to the problems and it has not worked. As per top executives of drug manufacturers, their experiments came empty handed and it was clear that achieving the targets is hard so eventually they stopped.
The other reason for lack of new antibiotics though is less forgivable if understandable. Very less in the industry will publically admit that investing in antibiotics is not that much attractive but if kept resistance aside existing drugs work well. Though the drug resistance problem is a small problem the drugs to overcome them is also small. And it gets further restricted by the fact that the poor countries who cannot afford the flashy drugs are suffering the most.
