The New Straits Times, August 2, 1999
Q: In the light of the possible contamination of chicken meat with antibiotics like chloramphenicol, could you please explain about "antibiotic resistance"?
A: "Antibiotic resistance" is a phenomenon whereby the microbes are learning to fight back. In other words, they are slowly adapting such that they can resist the anti-microbial action of antibiotics, making them no longer as effective.
Thus the microbes are said to be resistant to a particular antibiotic, or even in some situations to a class of antibiotics. In this case a type of superbug has been "created" that will respond only to the most potent (normally with higher risks) antibiotics. A vicious cycle is created if the more potent antibiotic is continuously being misused.
In fact, many commented that this is what is now happening throughout the world. That the range of antibiotics once deemed adequate to treat many of the commonly occurring infectious diseases are becoming useless and redundant. On the other hand, more resistant types of microbes might be emerging in which there are no known effective drugs available to deal with them. For example, it has been recorded in the United States that some new strains of microbes responsible for tuberculosis are becoming resistant up to as many as 11 types of drugs. In Malaysia too cases of resistant strains have been reported.
All these mean that we are increasingly being put in a very vulnerable position and this risk is recognised by international bodies including the World Health Organisation. The seriousness of the situation has made it an important topic of discussion among even the lay public, and not just the medical fraternity.
This is an important development because the public has an equally crucial role to play in curbing the occurrence of antibiotic-resistant bacteria. Being ultimately at the receiving end, consumers are in the best position to check the misuse of antibiotics. Such misuses include the improper use of the drug (more aptly called "irrational" use) or otherwise the total abuse of the substance. The latter can be illustrated in cases of routine use of drugs like chloramphenicol and nitrofuraninm, an animal feed. This of course needs constant monitoring and surveillance by the various authorities, and the passing of laws to curb such unwarranted usage.
The case of misuse too should be of concern. This includes the use of the drug when it is actually not required. A case in point is the use of antibiotics in the treatment of viral infection (for example, in some cases of cough and cold). This too is a global problem when patients with such complaints invariably are given antibiotics -- sometimes without any medical justification.
Another problem of misuse is the tendency to prescribe drugs in a "trendy" way. As a result of aggressive drug advertisement and promotion, some health-care providers are persuaded into using the latest antibiotics, which are usually the most expensive -- giving the impression that expensive drugs are the best -- whereas there are still other well-proven "old" cost-effective antibiotics that could justifiably be used. In many hospitals this is ensured through an antibiotic audit system so that any inappropriate use could be identified and stemmed out of practice.
The emergence of antibiotic resistance is further compounded in cases where patients, when correctly prescribed the drug, are not bothered to complete the course of treatment. This results in the microbes not being "killed" completely, and at a later stage would flare up again, this time maybe more resistant to the same drug. This is the very concern affecting us when such residual drugs are present in our food since it can promote the emergence of resistant-organisms over a long period of time.
Similarly, any unused (or unfinished) antibiotics must not be consumed again for the seemingly same ailment without contacting a health professional. The risk is too high. The drug may not be the suitable choice for the infection, and this can lead to unnecessary complications. Moreoever, the drug may have lost its efficacy normally due to improper storage conditions.
On the hand, it is also often alleged that "patient pressure" to prescribe more and more antibiotics is one of the reasons for misuse. At times they resort to buying antibiotics illegally (namely without producing a valid prescription) from unscrupulous drug outlets, including some pharmacies. Similar situations have been cited for farmers obtaining such drugs for their animal feed.
The problems associated with antibiotic resistance thus are many fold and involves a number of parties. Some are more interested in quick monetary gain instead of the long-term health benefit of the public at large. This is an irresponsible attitude and downright unethical because it exposes all of us to undue danger.
It is therefore crucial to realise that antibiotics, once regarded as a miracle cure, are fast losing their place in modern drug treatment. Most of the propblems attributed to them are preventable if only we exercise some rationality in their use. The role of the public in ensuring this is therefore very crucial. They must acquire objective information about antibiotics that are given to them and fully understand the implications of using the drug.
