Antibiotics' losing battle against microbes!

Repeated warnings by medical scientists and numerous studies conducted both by international as well as local research bodies have more than once come up with stark reminders against the dangers of improper, excessive and non-prescribed use and over-the-counter (OTC) sale of antibiotics. Still worse, indiscriminate use of antibiotics in poultry, fish and veterinary feeds has greatly compromised the potency of the anti-microbial drugs. According to a study, some 12 common antibiotics proved ineffective against common diseases like diarrhoea, urinary tract infection, lung infection and treatment of various wounds. A study conducted in 2016 by a pro-environment body Poribesh Bachao Andolan (Proba) found that 56 per cent of the antibiotics prescribed for patients in Dhaka proved mostly ineffective as the microbes had grown resistant to antibiotics. The situation has hardly improved since then. On the contrary, it has only changed for the worse. However, it is not only in Bangladesh, globally, too, the picture is rather grim. A 2014 review commission by the UK government in a report titled, 'Antimicrobial resistance: Tracking a crisis for the health and wealth of nations' in a broad brush estimate forecast that a continued rise in antimicrobial resistance (AMR) might lead to 10 million people of the world dying every year by 2050 and a reduction of 2.0 per cent to 3.5 per cent of global GDP. That would cost the world to the tune of US$100 trillion. Of the people to die annually due to AMR, Bangladesh will have also its share, thanks to unchecked use of antibiotics taking advantage of the lack of blood culture facilities at the district-level hospitals and clinics. Add to that the aggressive marketing policy of drug companies which is largely behind the rampant use of antibiotics despite the stern warnings issued by concerned study and research groups against the hazards such abuse of antibiotics pose to public health.

The National Antibiotics Resistance Survey was conducted between 2017 and June 2023. The Institute of Epidemiology Disease Control and Research (IEDCR) released the alarming findings of the study. Over the five years that the study was conducted, antibiotic resistance in the country increased by 11 per cent, while the efficacy of some commonly used antibiotics decreased by up to 82 per cent in 2023 compared to 71 per cent in 2022. In fact, antibiotics resistant bacteria have been proliferating at an alarming rate in the country. But as no new class of anti-bacterial drugs or antibiotics have been developed during the last three decades or so, doctors have to make do with whatever they have in hand to treat patients suffering from bacterial infections. Doctors are concerned that it is becoming difficult to save lives during surgery since, for instance, cephalosporin, a broad spectrum of bactericidal antibiotics, is becoming resistant to bacteria. But when it comes to the case of multidrug-resistant tuberculosis among surgery patients, it is really a crisis situation they face. It is against this dreary background that the International Centre for Diarrhoeal Disease Research, Bangladesh (icdr,b), recently revealed that there has been widespread colonization by drug-resistant pathogens in Bangladesh. And newborns are being colonised at alarming rate by such dangerous pathogens. Here, colonisation refers to the presence of bacteria in or on the body without causing any immediate disease. But these bacteria can spread and later trigger infections that are extremely difficult to treat.

As the study report further goes, 81 per cent of the newborns in neonatal ICUs were colonised by Klebsiella pneumoniae which is resistant to the drug carbapenem. Notably. Carbapenem is a powerful broad spectrum antibiotic used against serious bacterial infections that have not responded to other treatments. So, consider the danger the newborns are exposed to as they have practically no treatment against the drug-resistant pathogens, which the newborns acquired from hospital. Similar colonies of drug-resistant bacteria were found in adult ICUs and at the community level raising infection risks and prolonging hospital stays. The Antimicrobial Resistance (AMR) Research Unit at icddr,b presented the findings of the multi-country 'Antibiotic Resistance in communities and hospitals (ARCH)' study. The ARCH study is the first one to systematically investigate colonisation of AMR pathogens in both communities and hospitals. In this connection, the ARCH 1.0 was conducted in 2019 which detected high levels of resistant bacteria among both healthy individuals in communities and hospitalised patients. Extended-spectrum cephalosporin-resistant Enterobacterales (ESCrE) variety of bacteria were found to be highly prevalent in both communities (78 per cent) and hospitals (82 per cent). To note, Enterobacterales is a group of bacteria that can colonise the gut of healthy individuals without causing infection. ARCH 2.0 study, on the other hand, highlighted critical risks of newborns and ICU patients. In NICUs, 81 per cent of the babies were colonized with carbapenem-resistant bacteria.

The prospects look desperate. How are the health professionals going to face the new challenge of colonisation of both newborns and adults in hospitals as well as in the community by drug-resistant bacteria? The good news is that the ARCH study showed that infection prevention and control (IPC) interventions, such as strengthening health hygiene among healthcare workers and improving environmental cleaning can substantially reduce colonisation with resistant organisms and lower bloodstream infection in NICUs. In fact, it is the senseless use of the anti-bacterial drug that brought things to such a pass. Until scientists are able to break new ground in developing a new class of antibiotics to fight these antibiotic-resistant superbugs, public health will be facing a big challenge here at home as well as globally.

But until the crack of that new dawn in medical research, it is going to be the phase of managing with existing resources in dealing with public health. In that case, the government will have to strictly control the use of antibiotics. Strict monitoring should be mounted so the drug stores may not sell antibiotics and other critical drugs without prescriptions. Another issue the public health authority will be required to give serious attention to. Many of the drugstore operators are also not registered compounders. But they prescribe medicines. The poor, unlettered working maids and day labourers are their customers and even patients. There should be a nationwide crackdown against these drug-sellers doubling as doctors and other quacks across the country. Last but not least, the drug companies need also to respond to the public health concern of the nation.

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