Three years ago, The Lancet medical journal reported bacteria resistance to the antibiotic Colistin in some animals and human. While cases of bacterial resistance to antibiotics isn’t a new phenomenon, but to antibiotics of last resort this sounded an alarm for scientists globally and amplified the gravity of a potential public health crisis
What this mean is that once again humanity is heading for a post-antibiotic era, in which common infections and minor injuries can once again kill human and animals. Cancer treatments such as chemotherapy and radiotherapy, which depend on antibiotics to fight off infections, would be too dangerous to use.
The success rates of life-saving transplant operations would disintegrate, routine surgical operations would be too dangerous to carry out, and childbirth deaths would likely skyrocket.
Resistance has been identified as one of the biggest threats to human health globally. While the antibiotic arsenal dwindles in effectiveness, new antibiotics with novel modes of action are urgently needed
In cushioning the world from experiencing the end of the antibiotic era we must now understand that antibiotics cannot be utilised and handled just like other conventional medications like anti-inflammatory, anti-hypertensive, anti-diabetic medicaments are handled.
Bacteria have the potential to adapt to antibiotic exposure and therefore antibiotic resistance. This adaptation is achieved either by alterations of the genetic makeup of the bacterial DNA through point mutations and DNA transfer by plasmid conjugation. Biochemical alterations of the bacterial cells, for instance, inhibition of entry of antibiotics or efflux by bacterial pumps can also lead to antibiotic resistance. It is therefore critical that we promote the judicious use of antibiotics before we plunge into this end or abyss that we seem to be dangling precariously at the verge of.
capitalistic trends
First, we have to understand that the process of drug discovery and development is very tedious, complex, expensive and long. Averagely the process takes up to 20 years or more. This therefore means that if we are to continue with the shotgun approach to infectious diseases, as is a norm today, we will have more patients infected with multi-resistant bacteria and super bugs.
This will lead to increased infectious diseases-related morbidities and moralities. To slow down this arrival to the end of the antibiotic era, we must now promote the principles of antibiotic therapy, some of which are discussed in the subsequent paragraphs of this article.
The use of broad-spectrum antibiotics in empirical therapy — drug selections based on experience and relevant clinical observation and information, including knowledge of current resistance patterns in suspected pathogens and disease prevalence studies even though effective — has resulted in the selection of highly resistant bacterial strains.
Secondly, we must champion the evidence-based approach of medicine practice — the conscientious, explicit, judicious and reasonable use of modern, best evidence in making decisions about the care of individual patients. This approach which tends to optimise decision-making in medical practice by emphasising the use of evidence from well-designed and well-conducted research will ensure that antibiotics are reserved for treatable infections. Viral infections such as cold and flu, for example, do not warrant antibiotic use and antibiotics must not be prescribed.
The pharmaceutical industry has today been encumbered with capitalistic trends, with prescribers and dispensers promoting polypharmacy, which involves the concurrent use of multiples medications by patients.
While polypharmacy is common, especially in the elderly owing to their co-morbidities, we must now minimise polypharmacy when using antibiotics. Multiple antibiotics can act in synergism; penicillin antibiotics and aminoglycosides, for example, have shown greater effects when combined. However, the use of multiple antibiotics can also increase the risk of developing antibiotic resistance.
Patient education
The use of multiple antibiotics increases the spectrum of bacteria killed, and this can include the eradication of bacteria which form part of the normal flora like in the pharynx and gastrointestinal and genitourinary systems. This bacteria forming the normal flora compete for nutrients, occupying binding sites that would otherwise be occupied by pathogenic bacteria. Loss of normal flora would therefore allow resistant pathogens to overgrow.
It’s increasingly becoming evident that different individuals respond to the same drugs differently, hence, the individualised approach towards patient care. The variation in patient response to the same drugs can be explained by difference in demographics, medical and family history, genomics, clinical data and personal preferences.
Genomic variations would for example mean that different patients metabolise the same drugs differently. This would therefore mean that dose calculations for different patients would not be universal, as it is assumed in traditional practice. Adopting Individualised Patient Care and having drugs individually tailored in dose and regimens to meet patient needs will be a great step in reducing antibiotic resistance, as it will promote optimal response to antibiotics.
Patients are the end users of medications. It’s therefore important that healthcare professionals integrate patients into this fight against antibiotic resistance. Patient education should therefore be a key element of antibiotic therapy and over-the-counter sale of antibiotics should be minimised. Patients should be informed that they are on antibiotics therapy. Importantly they should be educated on why they should complete their antibiotic doses and why they should not misuse antibiotics.
The writer is a medical student at Kenyatta University
