Wonder drugs unleashing superbugs, microbial terror
It’s a ticking time bomb that threatens to rip apart the core of modern medicine. The indiscriminate use of antibiotics has unleashed deadly strains of bacteria, making even common infections life-threatening. These “superbugs”, having developed immunity even against the strongest of antibiotics over the years, threaten to take us back to the pre-antibiotic era. The WHO has rightly warned that “many common infections will no longer have a cure and, once again, could kill unabated”.
Antibiotics are meant to neutralize dangerous bacteria or restrain their growth, but their irrational use has led to the emergence of dangerous bacterial strains against which even the most powerful antibiotics have stopped working. This phenomenon, called antimicrobial resistance (AMR), is basically a natural process caused by genetic mutations. But the wrong and excessive use of antibiotics has hastened it. The disturbing trend of over-the-counter sales of antibiotics to patients who indulge in self-medication is a major factor contributing to this grave public threat.
AMR causes thousands of deaths worldwide every year, but the problem has acquired alarming proportions in India, where antibiotic sales registered a 40% increase between 2005 and 2010. The country has witnessed a whopping 95% rise in pneumonia cases and blood and wound infections, which cannot be cured even by last-resort drugs, in the last one decade alone. According to a WHO report, India and China account for half of the 1.5 lakh deaths caused by multi-drug-resistant tuberculosis every year. These frightening findings demand immediate action.
Realizing the magnitude of the problem, the WHO had come forward with a Global Strategy for Containment of Antimicrobial Resistance in 2001. Ten years later, India conceived its own national policy on antibiotics after the problem first came to public notice in the country with a report in Lancet, a leading medical journal, claiming the emergence of a new antibiotic resistance phenomenon in the form of the enzyme NDM-1 (New Delhi metallo-B lactamase-1). The report claimed that the enzyme was produced by a gene found in a Swedish patient who had undergone surgery in New Delhi. The gene could be transferred between the Klebsiella pneumoniae and E. coli bacterial species, thus making them resistant to all known antibiotics. The bacteria causing hospital-acquired infections are much more lethal than the ones found in community settings.
The WHO report caused an uproar, prompting the union health ministry to constitute a task force to recommend a policy on antibiotics. The taskforce recommended several remedial measures, including availability of carbapenems, considered last-resort drugs, only in tertiary hospitals. After sitting on the recommendations for over two years, the government is now working on a new antibiotic policy.
We can ward off the catastrophe by developing new antibiotics, but the drug development pipeline is running dry. The last class of antibiotics was developed in 1987. Research on antibiotics is not viewed as profitable owing to their short duration of use, longer research span and high R&D costs. There is a dire need to develop new antimicrobials through public-private partnerships.
Since India lacks reliable data on AMR, a national survey should be conducted to gauge the extent of the problem. Some organisations, like the Emerging Antimicrobial Resistance Society (EARS), are working towards collection of data and creating awareness, but government support is a must. Doctors and hospitals should join hands to take on this threat through an antibiotic protocol, which should be implemented across all hospitals in the country. Let’s all gear up for this challenge before it is too late.
The writer is Dr Manu Chaudhary, a scientist working on antimicrobial resistance, and chairperson of Emerging Antimicrobial Resistance Society (EARS), an NGO.