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The war against antibiotic resistance; the role of government & the general public

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By Tobias Mapulanga

Antibiotic resistance has remained a major public health challenge the world over. The resistance comes about when pathogenic bacteria escape the killing mechanisms of antibiotics and adapt to grow and reproduce in the presence of the drugs.

People affected by antibiotic resistance spend more days in the hospital which results in high cost of treatment. Antibiotic resistance also result treatment failure, greater disability and even death. Currently, the estimated cost of dealing with the problem world-wide is pegged at tens of billions of USD.

 Origin

The development of resistance to antibiotics is primarily a natural phenomenon resulting from spontaneous mutation of the genes whose protein products are targeted by various antibiotics as bacteria multiply. The resultant sub-population of antibiotic resistant bacteria does not readily increase any further since it is suppressed by a huge population of good bacteria found on our bodies.

However, societal pressures such as use, underuse, overuse or misuse of antibiotics can upset this balance of nature in favour of proliferation of these naturally existing clones of antibiotic resistant bacteria. Every time you use antibiotics, they kill all susceptible bacteria whether good or bad. However, they leave behind antibiotic resistant bacteria to flourish without competition for nutrition and binding sites and therefore have the capacity to cause diseases and spread to other people.

antimicrobial resistance1

The relationship between the use of antibiotics and development of antibiotic resistance; within the population of good bacteria (in green) found on our body or animal bodies are sub-populations of antibiotic resistant bacteria (the bad ones in orange). The good bacteria suppress the bad ones through (among other mechanisms) competition for food and binding sites. Once one takes antibiotics, the good ones are eliminated leaving behind the bad ones unsuppressed. The bad ones (antibiotic resistant) in turn proliferate and cause diseases that are difficult to treat.

Antibiotics are used extensively and inappropriately in animal husbandly and aquaculture for growth promotion and to prevent infections. In human medicine, some clinicians prescribe antibiotics for non-bacterial infections such as flu and viral diarrhoea even though antibiotics don’t work in these conditions.

On the other hand, many patients do not to finish the prescribed course of antibiotics simply because they have started feeling better. Others share their dose of antibiotics with family and friends. In Malawi, just as in many African countries, one can buy virtually any type of antibiotics from local shops or street vendors without a prescription. Drug storage in these sources is another problem. Drugs are often left to roast under direct sunshine by vendors and under soaring temperatures by shop owners. The active ingredients of some drugs may degrade under such storage conditions, a factor that may significantly reduce its concentration in the drugs and therefore increasing the chance of bacteria developing resistance when exposed to such drugs. These are just examples of dangerous practices.

Antibiotic resistance a time bomb

It takes over 10 years of rigorous scientific research costing up to one billion USD to develop a single candidate antibiotic from bench to bedside. Sadly it only takes less than 24 months before strains of antibiotic resistant bacteria appear in the environment.  This happens even when there is restricted use of the new product by clinical microbiologists and consultants. Reserving new antibiotics for use as last resort is a standard clinical practice in the treatment of infectious diseases. The draw-back to this practice is that the pharmaceutical industry is restricted from recovering their capital invested in drug discovery research within a reasonable period of time.

Furthermore big pharmaceutical companies who fund such projects are based in the developed world where infectious diseases are less prevalent. As such, they would rather invest in drugs that are used in the treatment of non-communicable diseases such as diabetes, heart diseases and cancer than spend money on antibiotics since the market for the former is readily available in the developed world. As such, research in the area of antibiotic discovery has been hampered as a result of funding issues.

With pathogenic bacteria fast developing resistance to commonly used antibiotics, at the very moment when pharmaceutical giants are not particularly keen to invest in research in antibiotic discovery, it is not rocket science to deduce, that we are sitting on a time bomb. The threat of the impending public health disaster is real unless we put in place measures to slow down the evolution of antibiotic resistance. We should take collective responsibility to implement measures that will slow down this phenomenon.

 Slowing down the phenomenon

To slow down antibiotic resistance by pathogenic bacteria it will be wise to stop buying antibiotics from vendors and unlicensed local shops. Instead people must get a prescription from doctors and buy the drugs from a registered pharmacists or dispenser

Additionally the government must enforce laws that require prescription-only drugs to be dispensed or sold only by qualified and registered personnel. Government must also regulate the use of antibiotics in animal husbandly.

On the same token people should stop sharing antibiotics and instead go to the hospital whenever one feels unwell to see doctors since they are better placed to prescribe the right treatment for illnesses. When given the prescriptions patients must stick to the prescribed antibiotic regimens even when they start getting better. Neither should they save the drugs for them to use next time they get ill.

Doctors must practice evidence based medicine and refrain from prescribing antibiotics when they are not necessary. And also the behaviour of enticing doctors to prescribe antibiotics when they are not necessary must be put to halt.

It will also be required of the Ministry of Health to strengthen the existing surveillance systems to monitor patterns of antibiotic resistance. Healthcare staff must follow current infection control guidelines when discharging their duties.

Healthy lifestyle and habits including proper diet, exercise, and sleeping patterns as well as good personal hygiene such as frequent hand washing must be adopted to help prevent illness in the first place. This will in turn will to help prevent the overuse or misuse of antibiotics.

Finally, government must invest more in preventive healthcare services through provision of health education, sources of safe & potable water to all Malawians, encourage good environmental sanitation and strengthen immunization programs. Its the same old adage, “prevention is better than cure.”

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