A friend of mine picked up a nasty infection when he went to hospital for a surgical procedure recently. He came out looking like a wreck, a gaunt shadow of himself. Ravaged by a “superbug”, he had to take a slew of drugs, at a financial and physical cost.
At least he finally won the battle. Not everyone does these days. An estimated 700,000 people worldwide die each year from infections resistant to common antibiotics, says the Review on Antimicrobial Resistance (amr-review.org). Among them: roughly 60,000 newborn babies in India.
More and more infections are getting harder to treat – pneumonia, tuberculosis (TB), and gonorrhoea. Bacteria are constantly mutating to develop resistance to antibiotics; some are now resistant to one or two, the “superbugs” are resistant to many.
Multi-drug-resistant TB is now everywhere, including Malaysia. It is much, much harder to treat, sometimes requiring two-year-long treatments with costlier antibiotics. In India, there is now “totally drug-resistant” TB. We’re doomed if that spreads.
The Review says that if nothing is done about the increasing ineffectiveness of antibiotics, 10 million people will die in 2050.
The “antibiotic apocalypse” may be one of the “greatest threats to mankind” now. These aren’t my words, but those of top health officials globally. Britain’s chief medical officer Prof Dame Sally Davies has said the problem is “a ticking time bomb” which could “end modern medicine”.
It will take us back to the dark days when even a cut or scratch could result in death. Organ transplants would be out of the question. Surgery, including caesarean sections, joint replacements, as well as chemotherapy for cancer, could be life-threatening.
Nov 14 to 20 was World Antibiotic Awareness Week. Led by the World Health Organisation and supported by the Health Ministry here, the campaign theme, “Handle With Care” underscored the fact that antibiotics are a precious resource that should only be used with great care.
There has been grave misuse and overuse of these miracle drugs. The public demands them, and GPs dish them out, even for viral conditions. Antibiotics work only against bacteria; they are useless against viruses.
“Antibiotics are being prescribed unnecessarily for common colds, coughs, sore throats and gastroenteritis which are usually viral in origin and do not require antibiotics,” says Assoc Prof Dr Sasheela Sri La Sri Ponnampalavanar, an infectious diseases consultant at Universiti Malaya Medical Centre (UMMC).
One study at UMMC found 13% of dengue patients had been given antibiotics before they arrived at the hospital, mostly by their GPs. Another study in Selangor found more than a third of GPs said their patients would change doctors if their request for antibiotics was not met.
Meanwhile, the meat industry pumps animals with antibiotics for growth, to help fatten them up quickly, while the pharmaceutical industry is failing to invest in new antibiotics.
The meat industry often uses the same antibiotics used for humans, and at low doses, which makes it easier for bacteria to develop resistance. Imagine, we then consume this stuff.
Globally far more antibiotics are used for animals than humans – in the United States it’s an estimated 70% more.
Drug-resistant organisms have been found in the soil, sea and rivers, says Dr Sasheela. And, in a study, in poultry farms in Selangor.
Right now, there are no controls on the use of antibiotics by GPs. We know even less about the use of antibiotics in the local meat industry. That is alarming. A National Antimicrobial Resistance Committee has been set up to address this.
In the meantime, it’s we, the people, who must push for change. We can, where possible, avoid antibiotics, or at least question the necessity of taking them.
My daughter, who is approaching seven, has never taken antibiotics. I’ve resisted pressure to give her antibiotics for coughs and a chest infection. Her immune system fought off the infections naturally, while left intact was her microbiome, the delicate balance of microbes inside us now being linked to all kinds of things, from asthma to weight gain. Every time we take antibiotics, we risk upsetting this, and developing resistant bacteria on our skin and bodies.
We can also buy antibiotic-free meat. That way, we send a message back to the industry and protect ourselves against possible infection with drug-resistant bacteria.
Finally, we can wash our hands, especially when preparing food. Simple, but it helps.
In the long-term, we need big measures for big solutions. It’s possible. Sweden has done it. It created a little antibiotic sanctuary by strict restrictions on antibiotic use and banning the use of the drugs to promote growth in animals. Denmark too cut down antibiotic use in its meat industry. Hopefully, more countries will follow suit. Otherwise those warnings of an antibiotic apocalypse might come true.
Mangai Balasegaram writes mostly on health, but also delves into anything on being human. She has worked with international public health bodies and has a Masters in public health.