STOP ANTIBIOTIC ABUSE!

Science is interesting. You can bend it, you can stretch it sideways, but facts are stubborn. They do not change.

When a patient is sick, a lot of diagnostic tests are carried out as part of care. Some tests are done to pinpoint a diagnosis; others evaluate the severity of the disease; others help to guide us in the best treatment options; while others help us to evaluate the response to the treatment given.

One Tuesday morning during our postgraduate training, during a major ward round in the teaching hospital, a colleague went about the business of the day. He presented a patient to the team who had been in the ward for about five days. She was about 26 weeks pregnant and was with us because she had a urinary tract infection.

 By itself, that was no news. Urinary tract infections are quite common in pregnancy. The pregnancy hormones make the mother susceptible to the infections. In addition, the growing uterus distorts the urinary system, leading to incomplete emptying of the bladder when passing urine, further increasing this risk. It is one of the more common reasons for admitting pregnant women in hospitals before delivery.

The dramatic news though, was when the doctor stated at the end of his presentation, that the results of the urine test done revealed that the bacteria responsible for the mayhem, was not responding to any of the antibiotics we had in our arsenal! This test, which takes at least 72 hours to give us results, is a painstaking process of isolating the offending bacteria from the patient’s urine, growing it on a special plate with various antibiotics and establishing which ones are capable of killing the bacteria and which ones cannot cause it any harm.

The whole team in the ward round was perplexed. How do you tell the patient that despite being in the wards in search of a cure, we knew what was ailing her but did not have cure? We are not talking about cancer here, we are talking about something as simple as a urinary tract infection. We were stumped! All the antibiotics we were pumping into her were a waste of time.

How do we end up here? Experts have warned us repeatedly that we are consuming too much of antibiotics in our foods. The problem with this is that the antibiotics reaching our system, having gone through animals, are of variable doses. When bacteria are exposed to small amounts of antibiotics, whose dose is inadequate to wipe them out, they have an opportunity to develop resistance to these low doses. Eventually, when one needs to use the same antibiotic to treat these same bacteria, they have developed thick skin and will not be affected by the drug even in correct doses.

And then there is the cohort of patients who use antibiotics indiscriminately even when they are not warranted. These are the patients who get the influenza virus and refuse to leave the doctor’s consulting room without an antibiotic prescription. Parents are the greatest proponents of these bad practices when it comes to their children. So much so that a social media joke was coined, targeting parents, stating that a fever is not a sign of ceftriaxone (a potent injectable antibiotic) deficiency.

The other end of the spectrum has those patients who do not follow their antibiotic prescriptions to the letter. Once the symptoms subside, they never bother to complete the dose. They pose a danger, not only to themselves but also to the entire public. They frustrate care providers to the point of taking drastic measures to ensure compliance. This is how the Ministry of Health ended up having two patients with tuberculosis incarcerated for refusing to complete their treatment!

We must abide by prudent prescription practices if we do not want to wake up in the next 20 years and find ourselves having converted bacterial infections into terminal illnesses. We are all guilty. Doctors who do not abide by good prescription practices, pharmacists who sell antibiotics without a prescription from the doctor, patients who treat themselves by demanding unnecessary antibiotic prescriptions or buying these drugs across the counter from unscrupulous pharmacies, and farmers who pump their far, animals with unnecessary antibiotics to increase their yield at the expense of all of us.

What we fail to comprehend as a society is that antibiotic resistance does not affect only those abusing these important drugs. It affects all of us directly. The same bacteria causing pneumonia in one patient is the same one causing meningitis in another, while it is still the same one causing a urinary tract infection in the yet another. Once the patient with pneumonia is improperly treated and an antibiotic resistance develops, the resistant bacteria moves into the next victim and causes chaos in a different body system with equal vengeance.

It is also worth noting that once an antibiotic enters the body, it is not only going to treat the affected system. It travels all over the body and kills off all other bacteria present and responsive to it. It behaves like a terrorist attacking a mall. Despite having a specific target in mind, he will leave hundreds of casualties behind as collateral damage.

The antibiotic journey started Alexander Fleming in 1928, with his discovery of penicillin. If he were to wake up today, he will be extremely proud of the advances that have stemmed out of his discovery. However, he will probably have apoplexy at the thought that such a major discovery that has had such a dramatic impact on humankind, is about to be declared obsolete in less than a century.

This acceleration towards gross antibiotic resistance needs to be brought to a screeching halt. We must all understand that antibiotics are not sweets to be dished out like a cheap dessert with every meal. We must reverse the trend or perish!