World Health Day Special: Resist those bugs

Today's medicines are smart, but germs are smarter. Here's what you should know about resistance to antibiotics

woman refusing to take medicinesResistance towards antibiotics, also known as antimicrobial resistance, has increased in the recent years and is a global issue today. Many organisms, including those causing serious life-threatening infections have proved resistant to a number of antibiotics, including the newly discovered agents.

This is a worrisome situation. The World Health Organization [WHO] answers some commonly asked questions about antimicrobial resistance. It is also its theme for World Health Day this year.

What are antibiotics?

Infections that lead to illness and disease are caused by microorganisms [germs]. These organisms, also called microbes, can be of different types—bacteria, viruses, fungi or parasites.

Antibiotics or antimicrobial agents are medicines prepared from other living organisms that are used to treat infections caused by these microbes.

These medicines [such as penicillin, streptomycin and 150 others] have been useful to mankind for the past 70 years in combating the severity and spread of many of these diseases.

However, not all antimicrobial agents are antibiotics because some of them are not obtained from a living organism but are synthesised chemically. Nevertheless, the terms 'antibiotics' and 'antimicrobial agents' are used interchangeably for ease of communication.

What is antibiotic [antimicrobial] resistance?

Microorganisms that cause infections have devised mechanisms by which they are able to evade the action of antibiotics. This is broadly referred to as antimicrobial resistance, or resistance to antibiotics.

How does one develop resistance to antibiotics?

The emergence of resistance to antibiotics is a natural biological phenomenon. The use of antibiotics for any infection, in any dose or for any period of time, causes a selective pressure on the microbes present in the body.

Under optimal conditions, the majority of the infecting microbes get killed and the body's immune system deals with the rest. However, if a few resistant mutants remain, and the treatment is insufficient or the patient has a weakened immune system, the mutants can flourish. Thus treatment may fail and resistant microbes multiply.

Should I be concerned about antimicrobial resistance even if I am getting treated in thehospital?

If during the course of hospitalisation you are infected with an organism that is resistant to a number of antibiotics, your stay in the hospital could be prolonged. Such organisms, which are resistant to a number of agents, are often called multidrug-resistant organisms.

Such organisms could cause devastating infections, which fail to respond to any or all of the agents used to treat these infections. Failed treatment could lead to secondary complications, with the infection spreading to all systems in the body.

Such patients require constant medical and nursing attention and are housed in closed units called intensive care units. They also have a greater risk of death caused by such infections. When these patients harbouring multi-drug resistant organisms continue to stay in the intensive care unit of a hospital, it gives an opportunity for the organism to spread from one patient to another.

How do the bugs spread from one person to another?

Most multidrug-resistant organisms spread from one patient to another through the hands of doctors, nurses and other staff. Hospital staff—X-ray technicians, dialysis technicians and the like—is required to observe good hand hygiene, which involves washing hands or rubbing their hands with an approved disinfectant solution before and after contact with a patient.

This ensures that they do not pick up any organisms from patients they examine or care for. But if they do not follow good hand hygiene, microbes get a chance to move from an infected patient to the hands of staff, and then to the next patient the person touches or examines.

Can I develop antimicrobial resistance also due to other reasons?

Yes. Weak infection control practices and poor general hygiene in several healthcare facilities, facilitate emergence and spread of resistant organisms.

In some cases, the pressure to get the patient up and about along with the fear of losing the patient to another professional colleague [especially in the private sector] have encouraged the use of a combination of antibiotics to treat minor or non-existent infections.

Consequently, such patients harbour multidrug-resistant organisms in their body, which can then be easily passed on to others through poor infection control practices.

Can this be called 'inappropriate use of antibiotics'?

The term inappropriate use of antibiotics is a term applied to all forms of antibiotic misuse and abuse. Inappropriate use occurs when antibiotics are taken for too short a time, at too low a dose, at inadequate potency, or for the wrong disease.

It starts with the incorrect antibiotic being prescribed for a condition. Some conditions do not even warrant an antibiotic; however, innocent patients and relatives are coaxed into believing that taking an antibiotic medicine for just two days would work miracles for the condition.

Wrong doses, incomplete schedules and inadequate timing of the intake of an antibiotic are all examples of how an antimicrobial agent can be abused by medical practitioners.

High-end [and expensive] antibiotics are usually given to patients with a serious or critical illness admitted to the intensive care unit of a hospital. However, it is common to find such medicines given to patients being treated for a minor ailment on an outpatient basis in a clinic.

In what am I responsible for developing resistance to drugs?

Some patients hope to get rid of their ailment, however minor it may be, almost instantly. This is not possible with the usual antibiotics. Due to anxiety and impatience, they 'window shop' for a physician who would prescribe a 'strong' antibiotic to rid them of their condition in record time.

Worse, some people even walk into a pharmacy and ask for half a strip of ciprofloxacin or azithromycin without having a proper diagnosis or prescription from a physician.

Why is it important that I complete an antibiotics course prescribed to me?

Stopping treatment well before the schedule ends, just because you 'feel better', does not kill all the organisms causing the infection nor does it give time to eradicate it completely. Those bugs that survive reproduce, thus helping to propagate resistant strains.

In what ailments are antibiotics generally misused?

Undoubtedly, respiratory illnesses [the common cold, cough with or without fever, bronchitis, wheezing, a running nose, sore throat] and diarrhoeas are the most common ailments for which antibiotics are misused. Almost every episode of gastroenteritis is treated with varying doses of antibiotics for different lengths of time for different patients.

The situation is worse in the case of small children, who are given far too many antibiotics by general practitioners and other doctors.

Do cold and diarrhoea not need antibiotics?

The common cold, a running nose and sneezing are usually symptoms of viral infections. These organisms are smaller than bacteria and are often seasonal [though some of them can cause infection throughout the year].

Most diarrhoeas are self-limiting and may be caused by viruses. Antibiotics are effective against bacteria but have no effect on these viruses. Hence the common cold, a running nose and diarrhoeas are not cured by antibiotics.

In fact, use of antibiotics in diarrhoeas may kill the good bacteria normally present in the intestine. These bacteria produce several useful products [namely vitamins] for the body.

But if the mucus from my nose is yellow, does that mean I have an infection? Don't I need an antibiotic then?

No, the infection does not necessarily need an antibiotic; yellow or green mucus does not always mean that you have a bacterial infection. It is possible that the mucus has thickened and it could also change colour during a cold.

What can I do to ensure that I do not develop antimicrobial resistance?

  • Try to prevent infections by observing healthy and hygienic habits. Wash hands well with soap and water and dry them before touching other surfaces to prevent the spread of antibiotic-resistant organisms.
  • Go to a qualified doctor for consultation. This ensures proper diagnosis of the illness, which itself will determine whether an antibiotic is required to cure the infection. Like we mentioned before, many infections do not require antibiotics.
  • Do not take an antibiotic if it can be avoided.
  • Always follow the advice of a doctor before you start taking an antibiotic.
  • Do not buy an antibiotic over the counter at a pharmacy without visiting a doctor or without a valid prescription from a qualified doctor. Buy medicine only as per prescription and do not take whatever the pharmacy doles out to you.
  • Do not store any antibiotic after its expiry or after the course of antibiotics is over. Do not reuse any antibiotic without a valid prescription from a doctor.
  • Ask your pharmacist or doctor about the correct method to dispose leftover medicines.
  • Do not use medicines left over from a previous episode of illness just because it worked the last time.
  • Do not give medicines to another person for what seems to be a similar illness to yours. The same medicine may not help all ailments in all people the same way.
  • Do not stop an antibiotic course just because you or your child feels or looks better. The medicine needs to be administered for a full course in the correct dosage to act on the organism and eradicate the infection. Incomplete courses will only contribute to antibiotic resistance.

Information courtesy: World Health Organization [WHO]

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