Antibiotic resistance: New threat to public health

KOCHI: The medical fraternity, public health activists and policymakers are waking up to the threat posed by antibiotic-resistant microbes to public health. Antimicrobial resistance or AMR is the condition in which microorganisms that cause an infection develop the ability to survive the medicine intended to kill the microbes or suppress their growth.  The mutation of microbes and their ability to survive the antibiotics have been identified as one of the major public health concerns all over the world. Although a section of scientists feel some projections in this connection are highly exaggerated, the seriousness of the issue has been recognised by all concerned.

The antibiotic resistance is one of the serious health issues facing the country, says Dr Camilla Rodrigues, consultant microbiologist and chairperson of infection control committee of the Mumbai-based Hinduja Hospital.  Speaking to this newspaper on the sidelines of a workshop on critical care held by Medical Trust Hospital Dr Camilla said the medical professionals and the ordinary people needed to be fully aware of the situation.  "The government and other stakeholders are now aware of the situation, and we needed to spread the same to as many people as possible", she said.

A review of the AMR situation in the UK commissioned in 2014 when David Cameron was the Prime Minister had painted an alarming picture by stating that in 2050 more people will die of drug-resistant infections than by other diseases. "Although we don't have such a full-fledged study, the Indian Council of Medical Research has come out with treatment guidelines for antimicrobial use in common syndromes," she said. 

"The awareness level has certainly improved amongst the medical community especially in the area of pediatric care. I hope the practitioners of general medicine would also emulate their colleagues in the pediatric care/."  Stressing the need for adhering to a strict protocol for antibiotics use, she also pointed out the pitfalls of using them as part of self-medication, which has to be stopped. 

A particular dose of antibiotics which was successful at one point in time may not be showing similar efficiency at another time. The people will have to repose faith in their doctor and adhere to the prescription.  She also pointed out the danger involved in using antibiotics as a cure for viral infections.  "It is known since ages that antibiotics do not have any curative power in the treatment of viral fever and there is no meaning in consuming them in such cases," she pointed out.

The awareness about the misuse of antibiotics is not matter confined the field of medicine alone, she said and stressed on the need for bringing such awareness in the agriculture, poultry farming and animal husbandry.  At present, there are no restrictions on antibiotic use in agriculture, poultry farming, etc.  "We need to bring controls in these areas too," she said. According to Dr Jojo K. John of the Medical Trust Hospital, the AMR situation in Kerala is also a matter of grave concern. "The state government has formulated certain guidelines on the antibiotics, and I believe that it would be announced officially soon," he said. 

The guidelines will help in setting the parameters for the use of antibiotics. One of the major concerns in Kerala and rest of the country is the mutation of drug-resistant Klebsiella bacteria, he said. "I think the variety we have found in the country is unlike similar drug-resistant bacteria variants found in other parts of the world and this poses a serious challenge to the medical community", he said. 

Medical experts say klebsiella bacteria account for a good proportion of urinary tract infections, pneumonia, septicemias and soft tissue infections. Dr Jojo also expressed optimism about a new set of methods for culturing blood and other samples in a faster time-frame helping the treatment of the patient.  The time consumed in culturing is a major issue the doctors face in deciding a treatment protocol, he said.  "The results of culturing nowadays take 24 hours to a week in rare cases. Such a delay can be fatal in the case of patients in critical condition," he said.  "Culturing protocols now available, cutting down the result time to 2-3 hours, will be a great help for doctors."