Opinion Refusing the bitter pill

The potential of multidrug resistance spreading to all parts of our country and across other continents is indeed alarming; therefore,one should instead learn the lessons from such reports.

The emergence of such resistance is directly related to our massive abuse of antibiotics. It is a fact that our drug distribution management is not well-regulated,and that one can purchase any banned drug from a pharmacist without any prescription. To top this,the compliance of treatment is extremely poor. There is no way to control if the course of prescribed antibiotics by a qualified doctor is taken fully — since,often,when the symptoms start disappearing after few doses,patients often ignore the prescribed course. (One should never ignore the socio-economic aspect of the situation; purchasing a full course of medicine may not even have been possible.)

Additionally,excessive use of antibiotics in animal husbandry and agriculture has compounded the problem. That creates selection pressure in the environment; and only the fittest bacteria,in terms of antibiotic tolerance,survive. These resistant bacteria are difficult to tackle with commonly-available antibiotics. In this context,the threat becomes real: we may have strains of bacteria living around and within us that can withstand any antibiotics thrown at them.

It is more threatening if one considers the fact that once it is learnt how an antibiotic can be resisted,the information can horizontally be transferred from one bacterium to another,unrelated,bacterium that is present in the vicinity. Bacteria are not shy of sharing resistant strategies with others,an ability that plays a crucial role in the rapid spread of antibiotic resistance.

When penicillin was launched around World War II,it was hailed as a “miracle drug” which could cure common bacterial infections such as tuberculosis and pneumonia. However,like any miracle it did not last for very long,since bacteria quickly learnt to destroy penicillin and are now well adopted to tackle any antibiotic they encounter. This has brought us on the verge of medical disaster where,like in the pre-penicillin era,common infections could turn life-threatening.

What we need to remember is that in the era of globalisation,it is not a problem in isolation of India,or of any single country or region. Certainly,given the prevailing hygienic conditions,third world countries are more affected than the rest. The non-availability of new and effective antibiotics within the immediate future compounds the problem. Clinicians are looking for new antibiotics with novel modes of action,which would presumably be more difficult for bacteria to circumvent.

It is not as if there are no solutions in sight. The situation can certainly be dealt with through proper management and surveillance. Firstly,efforts should be focused on creating transparent surveillance across the country to estimate the severity and prevalence of drug resistance; we need not wait for another report in the Western media or by Western scientists. Over-prescription of drugs by doctors and pharmacists should be discouraged; and,moreover,there should be stricter control on the sale of antibiotics. None should be sold without a proper prescription.

However,this is a difficult task. Official control mostly does not work; and,given the size and diversity of our population,a challenging task of management lies ahead.

The writer is at the School of Life Sciences,JNU,Delhi