Only a global effort to stop misuse of antibiotics will save mankind from drug-resistant microbes.
We have been hearing a lot about superbugs in recent years for both right and wrong reasons. Right, because these bugs are difficult to treat with antibiotics, the wonder drugs of modern medicine, and, therefore, such superbugs could potentially cause illness and death on a large scale. The emergence of drug-resistant strains of such deadly diseases as tuberculosis and HIV are worrying signs of this. But it is wrong to focus solely on the superbugs because they are only the most visible manifestation of the prolonged abuse of antibiotics across the world. They are the tip of the iceberg called antimicrobial resistance.
Before the fortuitous discovery in 1928 of penicillin, our very first antibiotic, the major cause of death in mankind was infection due to microorganisms such as bacteria, fungi, parasites and viruses. Since then, antimicrobial agents — antibiotics and related drugs — have led to a dramatic drop in deaths from diseases that were previously widespread, untreatable and frequently fatal. Now this is under threat as disease-causing microbes become more and more resistant to our wonder drugs.
The World Health Organization is focusing on antimicrobial resistance on World Health Day, April 7. We are urging all to use antibiotics rationally as resistance to antibiotics is a global problem that cannot be contained in one country or one region of the world.
Developed countries have long been overusing antibiotics — broadly, antimicrobials — including in instances where they were not medically indicated. At the same time, in the developing world, inadequate quality, underuse and poor access to drugs are contributing factors. Through misuse, people have given an undue advantage to harmful microorganisms and squandered one of the greatest weapons in the modern medical arsenal.
Development of resistance in microbes is natural. Their genetic system randomly and frequently undergoes changes, a few of which confer protection against antibiotics. This is called antimicrobial resistance. It is a natural survival mechanism — but inappropriate use of antibiotics selects out the resistant bugs, which is to say that a shortened, incomplete or inappropriate dose of an antibiotic kills only those bugs that are most susceptible and leaves alive those that have some resistance to it.
They then reproduce, and thus pass on their genetic resistance. Aided by persistent and widespread inappropriate use of antibiotics, the resistance to multiple drugs appears in some bugs, giving rise to superbugs.
This genetic ingenuity keeps bugs a step ahead of us. Thus, as soon as antibiotics emerged, so did antibiotic resistance. Within a few months of the first extensive use of penicillin in 1940 — the first antibiotic to treat infectious diseases in humans — resistance to this drug was also reported.
Antimicrobial resistance has enormous social and personal costs. When infections become resistant to first-line antibiotics, treatment has to shift to secondand third-line drugs that are nearly always much more expensive and sometimes more toxic as well. The drugs needed to treat multidrug-resistant tuberculosis (MDR-TB) are over 100 times more expensive than the first-line drugs. In some countries, the high cost is prohibitive, with the result that some of these cases can no longer be treated. Also, resistance to currently effective drugs could destroy the hopes of survival for millions of people living with HIV.
Development of new antibiotics is expensive. When a new antibiotic is launched, after investing millions of dollars and years of research, its misuse renders it ineffective in a very short time. This discourages industry from undertaking research and development and, hence, the discovery of new antibiotics has slowed to a crawl. During the last 15 years, only two new classes of antibiotics have been discovered.
Superbugs — or multidrug-resistant bugs — are prevalent not just in developing countries. In this era of globalisation, either everyone is at risk or no one. Several superbugs are prevalent in the developed world, such as methicillin-resistant Staphylococcus aureus (MRSA), a bacterium responsible for several difficult-totreat infections that kill thousands of people every year. But there are more efforts to contain these superbugs in resourcerich settings because of better surveillance systems and higher awareness.
Combating superbugs and antimicrobial resistance is a technical challenge that cannot be addressed by health administrators alone. Misuse of antibiotics by prescribers and users as well as weak pharmaceutical regulatory mechanisms in most developing countries are also involved.
Preservation of the efficacy of the life-saving and precious resource of antibiotics cannot be taken lightly or left to a few individuals or experts. It is a global issue that requires global effort, if we are to avoid a reversion to the dreadful pre-antibiotic era, which would be disastrous for poverty alleviation, development and global efforts to make the world a better and more healthy place.
A legendary professor at Harvard Business School for 40 years, Georges Doriot was a pivotal player i..