Antibiotics; Miraculous or Life-threatening? The choice is yours…

On 3rd October 2020, an awareness program based on antimicrobial resistance was conducted by Swastha Naari. Antimicrobial resistance is a sensitive yet overlooked topic that has a potential for another outbreak, even more, dangerous than COVID-19. Yet, many people do not know about it. So, the program was conducted to educate general people about the importance of antimicrobials, emergence of resistance in our body and its ultimate disastrous consequences that may lead to the post-apocalyptic world.

An antimicrobial is an agent that kills microorganisms or stops their growth. Antimicrobial medicines can be grouped according to the microorganisms they primarily act against. For example,

• Antibiotics are effective against bacteria (in the treatment of tuberculosis, cholera, urinary tract infection, diphtheria, whooping cough, bacterial pneumonia)
• Antifungals are effective against fungi (in the treatment of ringworm, athlete’s foot, aspergillosis, fungal eye infections)
• Antivirals are effective against viruses (in the treatment of common cold, chickenpox, measles, influenza, AIDS, Ebola)
• Antiprotozoal is effective against protozoa (in the treatment of malaria, leishmaniasis (Kala-azar), amebiasis).

A myth usually exists among people that survival of microbes (bacteria, virus, protozoa, fungi) on or inside our body makes us ill. But this is not true. Millions of microbes reside inside us and do not cause any harm at all. They are also termed as good bacteria or normal flora. Normal flora is the microorganisms that live on another living organism (human or animal) or inanimate object without causing disease. In fact, good bacteria help our bodies digest food and absorb nutrients, and they produce several vitamins in the intestinal tract, including folic acid, niacin, and vitamins B6 and B12. According to research published in the journal Best Practice & Research Clinical Gastroenterology Trusted Source, beneficial bacteria may also protect us against their dangerous relatives that cause disease by crowding them out in the gut, producing acids that inhibit their growth, and stimulating the immune system to fight them off. These bacteria are found in many foods like:

• Yoghurt
• Buttermilk
• Cheeses with live active cultures

Other foods that contain friendly bacteria or good bacteria include fermented foods such as:

• Beer
• Sourdough bread
• Chocolate
• Kimchi

With the idea that live bacteria are advantageous to our health, the concept of probiotics was established in the early 20th century. And now, pharmaceutical companies have started marketing these products as probiotics; containing live bacteria. Probiotics are available in many forms, including supplement pills, suppositories, and creams. Probiotics are proposed to prevent and treat a variety of health conditions, such as:

• Diarrhoea (including diarrhoea caused by antibiotics)
• Irritable bowel syndrome
• Ulcerative colitis and Crohn’s disease
• Tooth decay, gingivitis, and periodontitis
• Eczema

But not all microbes are beneficial. Some organisms living outside our body, attack us through various routes and causes harmful diseases. Also, when our immune system becomes weak, the good bacteria in our body can become harmful and cause different diseases. And in treatment or prevention of these diseases, we need antimicrobial agents. Hence, the use of antimicrobial agents may be categorized as:

1. As a prophylaxis/prevention: Antimicrobials are widely used in prophylaxis of various conditions like to prevent wound infection after surgery or to prevent being infected of malaria if you are travelling to a place which with very high risk.
2. For the treatment of infections: In most of the cases, antimicrobials are used in the treatment of various diseases like tuberculosis, urinary tract infection, AIDS etc. In such cases, either single antimicrobial agent (monotherapy) or combination of two or more antimicrobials (combination therapy) is used to overcome the infection.
3. Post-treatment suppressive therapy: Sometimes, when an infection has been treated, the chances of recurrence becomes high in patients with a weak immune system. This is very prevalent in cases of herpes simplex virus (HSV) infection and other viral infection. In such circumstances, Doctors recommend a low dose of the same antimicrobial agent for a long run to prevent the chances of recurrence and transfer of the disease from one person to the other.

With all such advantages and benefits of antimicrobial agent, one might wonder how could the miraculous thing could become life-threatening? It is because of the risk of development of resistance of these agents against the harmful pathogens. Antimicrobial resistance (AMR or AR) is the ability of a pathogenic microbe to develop a resistance to the effects of an antimicrobial medication. Usually, the symptoms of any infection subside within a few days with the use of antimicrobials. This occurs due to a reduction in a load of microbes, not because the organism has been irradiated from our body. But with the myth, people usually do not follow all the instruction as given by Doctors or Pharmacist and do not complete the dose of medication in the recommended frequency. This leads to the development of resistant microbes, and next time when the patient suffers from some infection, previously used antimicrobial will not work. Negligence has become a key to the development of antimicrobial resistance and an approach to the post-antibiotic era.

However, not only the negligence of a single human, but the community is responsible for it as well. Improper sanitation in hospitals, dirty surfaces, irrational use of antimicrobials in raising the business in poultry farming, improper management of waste in the community all is equally responsible for the development of antimicrobial resistance. Through direct contact, uncooked meat, crops grown in soil containing resistant microbes, contaminated surfaces, contaminated foods and drinks, antimicrobial resistance transfers from one place to the other and ultimately results in harm to us, our family and our society as well.

Photo credit: Statista

According to research, by 2050, 10 million people will lose their lives because of antimicrobial-resistant infections if the negligence is continued at the same rate. Already, half of the global population is resistant to carbapenems, fluoroquinolones and cephalosporins. And post-antibiotic era, a time where people will be compelled to lose their lives because of the infections which were once treatable like scratched knee or sore throat is not far away. From an individual level, the risk of antimicrobial resistance leads to treatment failure; economic loses resistant bacteria in normal flora, other infections and side effects of various alternative medicine used in the treatment. In some cases, hospitalization may also be required in the treatment of superficial infections.

So, to prevent all these, roles from an individual level and community level must be realized by everyone.

Roles from an individual side includes:

1. Follow all the instructions as given by the doctor or pharmacist regarding medicines.
2. Do not share your medicines with others.
3. Take your medicine in the recommended dose and frequency.
4. Do not throw your medicine directly in the soil.
5. Sanitation and hygiene need to be appropriately maintained.
6. Vegetables and meat should be cooked properly before eating.

Roles from a community side includes:

1. Waste management should be done correctly.
2. Irrational use of antibiotics in flourishing the business must be avoided.
3. Awareness program should be held by inviting experts to educate people about the consequences of antimicrobial resistance.

Apart from these, if any information is to be needed or shared, make sure you take the lead from authentic sites. Some of them include:

• World Health Organization (WHO)
• The Global Antimicrobial Resistance Surveillance System (GLASS)
• Global Antibiotic Research and Development Partnership (GARDP)
• Interagency Coordination Group on Antimicrobial Resistance (IACG)
• Centres for disease control and prevention (CDC)