Issues of antibiotic resistance

For too long, humankind has taken for granted the antibiotics that have held dangerous germs at bay. It was only about 70 years ago that penicillin, the world’s first antibiotic, came into widespread use and revolutionised medicine. Its discoverer, Alexander Fleming, who won the Nobel Prize for his work, presciently warned that disease-causing organisms would become resistant if the drug was improperly used. And that is just what has transpired.

Although more antibiotics were subsequently discovered, these drugs have been given with such profligacy that pathogens resistant to them have evolved and spread with alarming rapidity. ‘Superbugs’ resistant to almost all antibiotics have become a problem, raising worries of a return to the bad old days if much greater care was not exercised when prescribing existing drugs and sufficient encouragement for finding new ones was lacking. Now, with its first global report on antimicrobial resistance, the World Health Organization has added its voice to the chorus of concern. The report has documented how bacterial resistance to antibiotics, including those of last resort, is a major health issue confronting all regions of the world. Without urgent, coordinated action, “the world is headed for a post-antibiotic era in which common infections and minor injuries, which have been treatable for decades, can once again kill,” Keiji Fukuda, the health agency’s Assistant Director-General for Health Security, has warned. The report also calls for greater emphasis on preventing infections from occurring, such as with better hygiene and by improving access to sanitation and clean water.

For India, preventing antibiotic resistance from spiralling has to be a matter of urgency. The healthcare burden placed by bacteria such as Escherichia coli and Klebsiella pneumoniae, which have become resistant to many antibiotics and cause difficult-to-treat infections, is already quite substantial. Bacteria that have acquired a ‘New Delhi metallo-beta-lactamase (NDM)’ gene are resistant to even last-resort carbapenem antibiotics, forcing doctors to turn to colistin, a drug that is more than 50 years old. Halting the indiscriminate use of antibiotics is vital. The Union Government has taken an important first step in that direction by introducing a stringent rule that prohibits medical stores from selling 24 key antibiotics without a doctor’s prescription. Much more needs to be done, including getting doctors to prescribe antibiotics only when essential. Hospitals must pay attention to proper infection control. In a country so large and populous, with widely differing levels of healthcare reach, curbing the rise of antibiotic resistance is not easy. But it must be done.