Earlier this week, Marc Sprenger, the Director of the WHO (World Health Organisation) Secretariat for Antibiotic Resistance sent out a fresh appeal to both prescribing doctors and antibiotic users across the world.
“The advent of antibiotics introduced a new era in medicine. But now, I fear we are moving backwards – to the world in which my parents lived, when bacterial infections were often lethal because there were no specific treatments available,” he said at the start of a lengthy article on what can be done to control antimicrobial resistance.
Those interested to read the full article may click here: http://who.int/mediacentre/commentaries/stop-antibiotic-resistance/en/ .
The sum and substance of Dr Sprenger’s article and the mass of information available on the websites of the WHO, the CDC (Centers for Disease Control), Atlanta and other repositories is this: In the space of just 50 years, antibiotics have moved from miracle drugs to completely useless chemicals! And this has happened for a variety of reasons, a variety of inadvisable actions on the part of prescribing doctors, antibiotic users, food processing units, agriculturists in many countries.
A lot of senior surgeons would remember the days when any surgical procedure would be given an “antibiotic cover” of chloramphenicol and ampicillin, started one or two days before surgery and continued for several days after the operation. The justification: to prevent post-operative infection. This really meant that the hospital management wanted to avoid the tedious task of ensuring aseptic conditions in the OR and the post-operative ward! This is just one example, and there are numerous others.
Doctors have a tendency, perhaps driven by persistent prompting from leading pharmaceutical companies to prescribe the ‘latest’ antibiotic that arrives on the market for each and every illness. This is a little bit like using a Bofors gun to shoot down a petty gangster on the street. The collateral damage has to be seen to be believed!
This tendency must change. Antibiotics should be prescribed only when absolutely necessary, after proper investigation of the nature of an infection and after conducting culture-sensitivity tests. Not to do so is lazy clinical practice and the consequences are there to everyone to see!
If doctors are to be blamed for this dangerous situation where most micro-organisms are resistant to once powerful and effective antibiotics, they are not the only ones. Patients who buy strong medicines and use them without a doctor’s prescription and chemist shop owners who cater to such demands are both culprits in this regard. Likewise, patients who stop their medication before finishing a prescribed course of antibiotics are also responsible to some extent.
The remedy for this is a multi-pronged action plan, across cities and towns in every country, all over the world. At one level, each prescribing doctor must exercise a measure of self-discipline in offering strong antibiotics to their patient, each patient must follow the advice of their doctor (both in the choice of antibiotic and in the duration of treatment), each pharmacy owner must insist that their clients bring a prescription to buy an antibiotic and each government must ensure that antibiotics are sold only to those who really need it.
At the global level, there are two events coming up in the near future. In September 2016, there will be a United Nations high-level meeting on antimicrobial resistance at the General Assembly in New York. Global leaders will meet to commit to leading the fight against antimicrobial resistance. More information on this event will be available on the WHO website in the next couple of weeks. The second is World Antibiotics Awareness Week (Nov 16-22), which was observed for the first time in 2015. These would be excellent opportunities for the entire medical fraternity to learn more about the subject.
Dr Sumit Ghoshal is a professional journalist with an MBBS qualification and almost three decades of experience. He has been writing all along on health issues in various mainstream publications and is currently a Contributing Editor with Business India magazine.