‘One shot’ medicines including antibiotics, ‘supposedly’ miracle cures for any and every illness, just do not work and will have severe repercussions not only on the patient but also on society. The ticking time-bomb is Antimicrobial Resistance (AMR) due to irrational use and abuse of precious antibiotics. This is the dire but timely message that [...]


Super-bug threat a ticking time-bomb

‘Rational use of precious antibiotics an urgent need’

‘One shot’ medicines including antibiotics, ‘supposedly’ miracle cures for any and every illness, just do not work and will have severe repercussions not only on the patient but also on society.

The ticking time-bomb is Antimicrobial Resistance (AMR) due to irrational use and abuse of precious antibiotics.

Dr. Samanmalee Gunasekara

This is the dire but timely message that comes from Dr. Samanmalee Gunasekara of the Sri Lanka College of Microbiologists this week as Sri Lanka and the world goes into ‘Antimicrobial Awareness Week’ (November 18-24) declared by the World Health Organization (WHO) with the theme ‘Spread Awareness, Stop Resistance’.

Why should people take serious note that they should not be popping antibiotics on a whim for any illness and why should doctors not be prescribing antibiotics?

Before answering this all-important question, Dr. Gunasekara explains that antibiotics are medications that work wonders in inhibiting growth and destroying bacteria which cause numerous diseases.

While reiterating that antibiotics are not effective and should never be prescribed or taken randomly for a viral infection [like COVID-19, the common cold or influenza (flu)] which is self-limiting and has to run its course, she points out that antibiotics should be used rationally and only when necessary.

“The irrational and inappropriate use of antibiotics is causing havoc around the world leaving a trail of AMR behind. The fears over AMR are grave – Public Health England has forecast that it will be the leading cause of death in 2050, felling about 10 million people. The worst-hit regions will be Asia and Africa. This is why we need to take action right now,” saysDr. Gunasekara.

The first ‘true’ antibiotic, penicillin, was discovered in 1928 by Alexander Fleming, Professor of Bacteriology at St. Mary’s Hospital, London, United Kingdom, revolutionizing medicine in the 20th century.

Now some of the commonly used antibiotics are penicillin, amoxicillin, cloxacillin, clarithromycin, ciprofloxacin and co-amoxiclav.

The reasons to scrupulously avoid irrational and inappropriate use of antibiotics, according to Dr. Gunasekara are:

n    If there is AMR, then the commonly-used antibiotics become ineffective, compelling moving onto stronger antibiotics (3rd-line antibiotics). This will not only cost more but the side-effects in the patient will also be more severe. (The usual side-effects range from nausea to vomiting, diarrhoea, a rash and allergies).

n    Inability to treat an infection as the bacteria have become tolerant to the antibiotic and survived. This resistance to antibiotics could end in the death of patients (both adults and children) because of super-bugs.

n    There is loss of normal flora (good bacteria) found in the gut (Escherichia colior E.coli); on the skin (Staphylococcus epidermidis);or in the mouth (Streptococcus salivarius K12) which give humans protection by battling with bad bacteria.

The other dangers of uncontrolled antibiotic use are from veterinary and agriculture spheres, she says.

Warning that AMR follows when in spite of taking an antibiotic, the bacteria are able to change their genetic structure for better survival, she looks at the Intensive Care Unit setting. If such resistance to bacteria occurs in one patient, it spreads very easily to others.

Such resistance to an infective agent may lead to death without a very good, effective antibiotic, cautions Dr. Gunasekara, pointing out that the pharmaceutical industry is not overly interested in producing new antibiotics.

“The antibiotic pipeline is drying up because the industry feels that the effort and cost of researching and performing clinical trials are not worth their while and do not bring in huge returns, unlike medications for non-communicable diseases (NCDs) such as diabetes which patients would be on lifelong.This is why we need to preserve the precious antibiotics available now,” she urges.

The good practices needed in hospitals to prevent AMR are:

n    Proper hand hygiene, use of personal protective equipment (PPE) when necessary and isolation of a very infectious patient

n    Vaccination

n    Proper waste disposal

In hospitals, there is ‘Antimicrobial Stewardship’ to see to the optimum use of antibiotics and minimise unintended side-effects. There is also on-the-run development of policies and guidelines on rational prescribing of antibiotics; infection prevention and control; and surveillance of antibiotic use/side-effects and resistance.

She requests doctors to review the antibiotic chart so that patients are given these doses only for a short duration.

A strong advocate that each and every one – doctors, nurses, administrators, pharmacists and also patients – has a collective responsibility, Dr. Gunasekara gives some dos and don’ts:

  • Patients should not buy and pharmacies should not sell antibiotics over-the-counter
  • Patients should get a prescription for antibiotics from a qualified doctor
  • Patients should stick to the recommended dose not take more or fewer, scrupulously follow the interval at which the antibiotic should be taken (whether morning and evening, etc.) and should not stop the antibiotic when they feel better, but take the course stipulated
  • Patients should not share any antibiotics with others seemingly having the same symptoms or take what is offered by another on the same grounds

Sri Lanka is part of an ongoing Global Project on Antibiotic Surveillance and is feeding data from hospitals.

Misuse of antibiotics in COVID-19

COVID-19 is a viral infection, says Dr. SamanmaleeGunasekara, stressing that antibiotics are not medications that should be prescribed for viruses.

She concedes that there have been many instances when some doctors have regrettably prescribed antibiotics on Day 1 of COVID-19. There has been heavy use of clarithromycin during this period without any indication for such use.

Antibiotics should only be given if there is a secondary bacterial infection after about a week of being affected by COVID-19.  The signs of such a bacterial infection should be confirmed through a clinical examination supported by blood tests and X-rays, she points out.

Dr. Gunasekara adds: “Otherwise, if from Day 1 a patient is given an antibiotic, if he/she develops severe disease such as pneumonia, the doctors are not left with any antibiotics to combat it but will have to go in for 3rdline antibiotics.”

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