THE REAL PLAGUE OF THE MODERN AGE: ANTIMICROBIAL RESISTANCE

 Alexander Fleming truly made one of the greatest discoveries of the 20th century with the discovery of penicillin. The first antimicrobial agent to be introduced in 1943. But the true age of antimicrobial agents began with Alfred Bertheim and Paul Ehrlich who introduced the agent slavasran in 1907 for its use as an antisyphyilitic agent. With the use of antibiotics naturally came antimicrobial resistance. A problem that was once thought to be an issue of the future but like global warming is an issue that is happening right now.

  The WHO definition of antimicrobial resistance is a microorganism's resistance to an antimicrobial drug that was once able to treat an infection by that microorganism. Meaning that the drug to which the microbe is resistant can no longer halt the growth or kill that organism.

   Antimicrobial resistance is a problem that plagues every nation in the world despite what statistics may say or nations may claim. It is a problem that can affect every individual alive regardless of age, gender, fitness, location et cetera. Every microbe be it bacteria, parasites, viruses and fungi are a threat since every microbe that is out there has the potential to become resistant to the drug that is designed to kill it. This is not much of a surprise since if less sophisticated cancer cells can become chemotherapy resistant it’s not much of a big deal that pathogenic microbes can do the same.

  To put the concept in simple terms a microbe acquires resistance when a given population of pathogenic microbes is initially exposed to an antimicrobial agent in the form of a prescribed antibiotic. But for some reason the patient does not continue the medication for the full prescribed term, either because he feels better and thus feels he is cured or due to its Side effects or because due to financial reasons takes a limited amount.  This abruptly ended therapy causes some of the pathogenic organisms to be eliminated, the reaming smaller population of this organism then undergo certain mutations that cause them to become resistant to that agent. Eventually the patient then spreads this mutated pathogen to other individuals and himself suffers from a relapse of the same infection.       Eventually when the pathogen population rises once again to disease causing levels. Only this time he will be having a treatment resistant infection. There are also other ways by which microbial resistance occurs such as buy use of heavy antibiotics in cattle.

  A person infected with a resistant strain is more likely to die from the infection than a non-resistant organism of the same kind. Such infections require treatment with agents that are more toxic and more expensive in some cases these not very effective. In recent years resistance is being detected agents of last resort such as Vancomycin and Carbapenems. This means that infections caused by these organism can be treated by no available antibiotic at all. To save such patients all the doctors can do is amputate or surgically remove the infected tissue, limb et cetera and hope that no microbe has found its way during the surgery elsewhere to cause a reinfection.  The problem now has importance of such magnitude that it has been suggested that an international treaty be signed to deal with the issue.

  With the advent of organisms such as extremely drug resistant tuberculosis which are resistant to multiple first line and second line drugs, it may indeed be a hard job to tackle this problem. But never the less we still must try to at least handle it.

• Simple task of setting up of antimicrobial stewardship programs can be a first step in hospitals.
• Hospitals should utilize proper procedures of microorganism culturing and antibiotic sensitivity testing.
• Proper procedures should be utilized for prescribing and utilization of reserve antibiotics only when really necessary.
• Patients should be properly counseled regarding the necessity of completion of the antibiotic course
• Individuals should stop buying and pharmacist should stop dispensing antibiotics without a prescription.
• Reduction of unnecessary antimicrobial usage where not required can be a major effective step. Such as incase of common cold, flu, or even in case of a simple diarrhea. They should be used only in case of serious infections and not for viral infections where they do not work.

  With the whole world more focused on issues of terrorism, wars and other threats the real threat to human life of antimicrobial resistance does not seem to be given much importance, though certain governments and organizations such as the WHO and CDC are doing their bit to create awareness of the issue. Antimicrobial resistance may very well be the cause of human extinction if not dealt with immediately.

  

----Raghuvir Keni