The New Straits Times, July 9, 2000
By Dzulkifli Abdul Razak
THE World Health Organisation recently repeated its reminder against the misuse of antibiotics, saying it will lead to the creation of "superbugs" that render antibiotics ineffective.
This "could take the world back to the time when minor infections killed", it warned. Superbugs could make existing antibiotics useless as early as 2010.
The WHO sounded the warning in its annual report on infectious diseases, Overcoming Antimicrobial Resistance. The report describes how all major infectious diseases, including tuberculosis, malaria, AIDS, pneumonia and diarrhoeal diseases are slowly becoming resistant to drugs.
In today's era where AIDS is "allowing" other opportunistic organisms to flourish more easily, antibiotic resistance is a global nightmare. Thus, while antibiotics continue to be a vital part of modern day medical armetarium, they need to be used judiciously, said Dr David Heymann, executive director for communicable diseases at WHO.
He stressed the need "to call on the world to mobilise a massive effort to make better use of these powerful weapons before the window of opportunity closes and before we move further towards the pre-antibiotic age."
Already, according to the US Centers for Disease Control and Prevention (CDC), "88,000 Americans a year die of infections they catch in hospitals and many are resistant to at least one antibiotic, thus complicating treatment".
British Health Minister John Denham has granted inspectors new powers of "naming and shaming" hospitals that have above average levels of infection in a bid to reduce the incidence of hospital acquired infections.
Antibiotic misuse can be in so many ways. One common way is the use of the drug when it is actually not required. A typical example is use of antibiotics in the treatment of viral infections (namely, in some coughs and colds). This is a global problem and a simple case of over-prescription.
Another form 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 hat expensive drugs are the best; whereas there are still other well-proven "old" cost-effective antibiotics that could justifiably be used.
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 may be more resistant to the same and similar drugs.
Over time, they evolve into fully resistant strains. Misuse of medications, particularly antibiotics, speeds this process.
This is the same concern when residual drugs are present in our food since they too can promote the emergence of resistant organisms over time.
In fact, WHO recommends that human antibiotics are not be used as growth promoters in animals. Reportedly half of the world's antibiotics are used on the farm, sometimes to treat illness but mostly to help animals grow bigger. That encourages drug-resistant germs which cause food poisoning, WHO said.
Any unused (or unfinished) antibiotics must not be consumed again for the seemingly same ailment, without getting professional advice. The risk is too high. The drug may not be suitable and can lead to resistance problems. Moreover, the drug may have lost its efficacy normally due to improper storage conditions. All these will compound the occurrence of resistance.
On the other hand, "patient pressure" is often cited as the reason for prescribing more antibiotics. Some resort to buying antibiotics illegally from unscrupulous drug outlets. Similar situations have been cited for farmers obtaining such drugs for their animal feed.
Misuse of drugs is not the only problem. The American Medical Association (AMA) is asking US regulators to complete their review of other antibacterial products and determine if they might contribute to the health threat created by excessive use of antibiotics. This includes antibacterial soaps which may be no more effective against germs than common soap.
Though it stopped short of suggesting that customers avoid using soaps, lotions and mouthwashes that advertise themselves as fighting bacteria, it did express strong doubts about the products' usefulness.
Myron Genel, chairman of AMA's Council of Scientific Affairs and a Yale University paediatrician was quoted as saying, "There's no evidence that they do any good and there's reason to suspect that they could contribute to a problem by helping to create antibiotic-resistant bacteria.
The problems associated with antibiotic resistance thus are many-fold and involves a number of parties. Some are more interested in quick monetary gains than that the long-term health benefits of the public. This is downright unethical as it exposes all of us to undue danger.
As mentioned by Dr Jeffrey Koplan, director of CDC and who helped WHO with the report, "We use the same antibiotics as other countries do," so resistance in one country is bad news for everybody.
As most of the problems attributed to the misuse are preventable, we must exercise some rationality in their use. In many hospitals for example, this is ensured through an antibiotic audit system where any inappropriate use could be identified and stemmed out of practice. Sadly this is still missing in some of our local practice settings.
The public too has a crucial role to play by increasing their level of awareness about the drugs given to them and fully understanding the implications of using them. Otherwise, antibiotics once regarded as the magic bullet, will soon be redundant as part modern drug treatment.
Recommended site on WHO report: http://www.who.int/infectious-disease-report/2000/index.html
