WHO has warned that the over prescription of antibiotics will lead to a global resistance to pathogenic microbes (infection causing bacteria & viruses). While many developed countries have strict guidelines on the prescription of antibiotics, third world countries are much more relaxed on the issue, often considering the profits, incentives and commissions to be made rather than the wellbeing of the patient and the global community at large.
For example, women that give birth in Indonesia are all given a course of Amoxicillin after birth “just in case” infection develops. With many doctors in Asia on low incomes, commissions from drug sales are often where they make their money. Self medication is also a huge problem in this society. Antibiotics (or any “prescription” drugs for that matter) are easily purchased at most pharmacies without any prescription at all. Even more shocking is that some backstreet “warungs” also stock a supply of antibiotics, usually selling to the “gentlemen” who have visited the local whorehouses.
“Antimicrobial resistance (AMR) causes an estimated 700,000 deaths annually worldwide, and every country is potentially affected. If not properly addressed, the number could grow to 10 million per year by 2050”.
What are antibiotics?
Antibiotics, through various actions, destroy or inhibit the growth of bacteria. The antibiotic may be specific, and targeted at a small group of bacteria, or it may be a broad-spectrum antibiotic, which means it will be effective against a large group of organisms. Most antibiotics are absorbed well through the gut, and are sold as tablets or syrups, but some do have to be injected.
Do antibiotics cure all infections?
No they do not. Antibiotics have no effect at all on infections caused by viruses, or fungi. Viruses cause all types of flu and colds, and most coughs and sore throats. Recovery from viral infections will happen in the same number of days with or without antibiotics. In some cases antibiotics will be prescribed for someone suffering a heavy viral infection to prevent bacterial overgrowth. Antibiotics will aggravate the condition of someone suffering a fungal infection. Many “healthy bacteria” that normally live around our bodies actually assist us in our wellbeing. These friendly bacteria are killed when broad-spectrum antibiotics are prescribed. This then leaves an open arena for pathogens like certain fungi (e.g. Candida), to take over. Interestingly enough, recovery from some bacterial infections will happen in the same number of days with or without antibiotics. Our bodies do have the ability to heal themselves in most circumstances.
What is “Antibiotic Resistance”?
When antibiotics are used to kill a certain group of bacteria, some of those bacteria may adapt, grow and multiply with a new found strength that is able to resist the antibiotic that was once effective in killing it. Each time an antibiotic is used, the chance of resistance increases. The resistance to any antibiotic is not limited to one person but affects the entire community in general. For example if Fred takes antibiotics (eg Amoxicillin) for every minor infection that he has, the bacteria will soon become resistant to that antibiotic. If John is then infected by a bacteria that has been passed on to him by Fred, it will be of no use for John to take Amoxicillin. The bacteria is already resistant.
This has been proven in communities worldwide. Penicillin, the very first antibiotic to be marketed, is now useless against most infections. Certain strains of antibiotic resistant Staphylococcus (Golden Staph.) have colonized in hospitals all over the globe. Malaria is resistant to Chloroquine in almost all high-risk Malaria regions (although strictly speaking Malaria is not a bacteria, but the same principle applies).
Five Strains of Bacteria that are Now Resistant
Antibiotic resistance risks returning us to an age where even simple cuts and scrapes can become deadly. For a glimpse of what could be commonplace in our future, here are five of the scariest antibiotic resistant bacteria from the last five years.
- Extensively drug-resistant Salmonella typhi
This highly contagious bacterium causes typhoid fever, a life-threatening infection that affects about 21 million people around the world every year. About 1% of those affected, or 223,000 people, will die. In November 2016, a strain of Salmonella typhi emerged in Pakistan. It was resistant to five antibiotics, leaving only one oral antibiotic (azithromycin) able to treat it.
- Extensively drug-resistant Mycobacterium tuberculosis
Mycobacterium tuberculosis is the world’s leading infectious killer, causing more than 1.7 million deaths every year. It’s estimated up to 13% of all new tuberculosis cases are multidrug-resistant, with Europe, including Russia, seeing the highest number of these cases.
- Pandrug-resistant Klebsiella pneumoniae
Klebsiella pneumoniae is a common bacterium found in the skin, intestines and soil. It causes a range of potentially deadly infections in people with compromised immune systems. As this bacterium is particularly prevalent in hospitals, it’s one of the most critical drug-resistant threats to public health. In 2013 there were 8,000 reports of multidrug-resistant Klebsiella pneumoniae in the United States alone, with a death rate of 50% for people with bloodstream infections.
- Pandrug-resistant Pseudomonas aeruginosa
Like Klebsiella pneumoniae, Pseudomonas aeruginosa is a commonly found bacterium that causes infections in people with compromised immune systems. Like Klebsiella pneumoniae, it’s particularly prevalent in hospitals. In the past five years, 29 cases of pandrug-resistant Pseudomonas aeruginosa infection have been reported in hospitals in England.
- Extensively drug-resistant Neisseria gonorrhoeae
There are an estimated 78 million global cases of Neisseria gonorrhea, which causes gonorrhea, a sexually transmitted infection affecting men and women. Although usually not deadly, serious and permanent health problems including infertility can result if the disease goes untreated. Around one-third of all Neisseria gonorrhea infections are resistant to at least one antibiotic. More worryingly, a new extensively drug-resistant “super gonorrhea”, resistant to all but one antibiotic, has been discovered.
Steps to reduce use of antibiotics
Try to avoid infections in the first place. If you do get one, use antibiotics correctly. The following steps can help:
Wash your hands often
- Use plain soap and water.
- Wash before preparing or eating food.
- Wash after using the bathroom, changing a diaper, sneezing, coughing, handling garbage and coming home from public places.
- Wash before and after treating a cut or wound or being near a sick person.
- Don’t share personal items like towels, razors, tweezers and nail clippers.
- Keep kitchen and bathrooms clean. You can clean surfaces with soap and water. Try to avoid products with added anti-bacterials.
- Don’t put purses, diaper bags, or gym bags on the kitchen table or counter.
- Wash wounds with regular soap and water.
Use over-the-counter antibiotic products such as neomycin (Neosporin and generic) or bacitracin only for cuts that look dirty.
Work with your doctor
- Don’t push for antibiotics with your doctor. If you don’t have a bacterial infection, ask how to relieve symptoms. Consumer demand is one of the major factors in the over-use of antibiotics.
- Fight it off. If symptoms are mild and complications unlikely, ask if you can delay treatment for a few days.
- Maintain a healthy lifestyle & diet.
- Take antibiotics as prescribed. Don’t skip doses or stop the medicine early.
- Don’t use leftover antibiotics to treat an infection.
Taking the wrong medicine allows bacteria to multiply.
If the household or personal product (cleaning solutions, soap, shampoo etc) says antibacterial, leave it on the shelf. Use vinegar, soap, or bicarb soda instead.
Bacterial resistance cannot be stopped; it is part of evolution itself. However it’s development and spread can be minimized by:
- Only using antibiotics when absolutely necessary.
- Knowing what sort of illnesses respond to antibiotics.
- Understanding that recovery from many illnesses will occur in the same time frame, with or without antibiotics.
Kim Patra is a qualified Midwife & Nurse Practioner who has been living and working in Bali for over 30 years. She now runs her own Private Practice & Mothers & Babies center at her Community Health Care office in Sanur.
Copyright © 2019 Kim Patra
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