by Angel John, Pharm.D
"Antibiotic resistance", when antibiotics can no longer cure bacterial infection, has been a concern for years and is considered one of the world's most critical public health threats. Antibiotic use is required and beneficial when prescribed and taken correctly, their value in patient care is enormous. However, these drugs have been used so widely and for so long that the infectious organisms the antibiotics are designed to kill have adapted to them, making these drugs less effective. An increased awarness is needed to educate consumers about when an antibiotic is needed for treatment purposes. People infected with antimicrobial-resistant organisms are more likely to have longer, more expensive hospital stays, and may be more likely to die as a result of the infection. “Antibiotics are losing their effectiveness at a rate that is both alarming and irreversible – similar to global warming," said Professor Dame Sallies (Cheif Medical Officer)
I have come across many patients with general common cold and cough symptoms who instantly believes taking an antibiotic is going to shorten the duration and cure. This mentality of patients need to be changed by increasing their knowledge base in the differences between a bacteria and a virus, and when the usage of an antibiotic comes into play. The reality is antibiotics do not fight infections caused by viruses like colds, sore throats, bronchitis, and some ear infections. Unnecessary usage of antibiotics to treat common ailments only lead to future antibiotic-resistant infections.
According to the Centers for Disease Control and Prevention (April 2011), antibiotic resistance in the United States costs an estimated $20 billion a year in excess health care costs, $35 million in other societal costs and more than 8 million additional days that people spend in the hospital.
How does the resistance occur?
The primary function of microbes is to reproduce, thrive and spread quickly and efficiently. Therefore, microbes adapt to their enviroments and change in ways that ensure their survival. If something stops their ability to grow, such as an antimicrobial, genetic changes can occur which will enable them to survive. Resistance can occur in several ways. One way is through mutation in the microbe during reproduction which allows them to evolve rapidly and adapt quickly to new enviromental conditions.
Inadequate diagnostics, where healthcare providers use incomplete or imperfect information to diagnose an infection and thus prescribe a broad spectrum antimicrobial could also accelerate resistance.
Another is through gene transfer, where drug resistant bacteria can transfer a copy of drug resistant DNA to others. One of the main problem has been the inappropriate usage of antimicrobials opening up the gateway for resistance. Sometimes healthcare providers will prescribe inappropriately, wishing to placate an insistent patient who has a viral infection or an as yet undiagnosed condition. Critically ill patients in the hospital requires heavy use of antibioitcs at times, which prones them to encoutner antimicrobial resistant microorganisms. The extensive use of antimicrobials and close contact among sick patients creates a fertile environment for the spread of antimicrobial resistant germs.
Scientists also believe that the practice of adding antibiotics to agricultural feed promotes drug resistance. More than half of the antibiotics produced in the United States are used for agricultural purposes. However, there is still much debate about whether drug-resistant microbes in animals pose a significant public health burden. According to an investigation in the Washington Post, of the 35 million pounds of antibiotic used in the US in 2008, 70 percent “went to pigs, chickens and cows.” Worldwide, that number is about 50 percent.
The Do's & Dont's for patients
No action today, No cure tomorrow
There are very few new antibiotics in development, so it is important to use our existing antibiotics wisely and make sure these lifesaving medicines continue to stay effective. Unless action is taken to prevent the emergence of resistance, some of the problems we could face include:
Many industralized countries in the world does not require prescription to obtain drugs from pharmacies. Due to the lack of laws & restriction on prescriptions, bacterial resistance has been an increasing problem in countries like India. UK is signed-up to the WHO European Strategic Action Plan on Antibiotic Resistance which encourages sharing of information, developing effective interventions to prevent and slow down the development of multi-resistant bacteria, and working together to stimulate the development of new drugs and diagnostics.
With this ongoing increase in antibiotic resistance, pharmacists can play a vital role in providing patients with advice about medicines. We are the first port of call for help and advice about how to treat common conditions such as coughs and colds, but also recognise more serious symptoms and know when patients need to seek further treatment. Educating the patient about antibiotics and its usages has been more crucial than ever to minimize the formation of antibiotic resistant bacteria.
New England Journal of Medicine
Center for Disease Control & Prevention
World Health Organization: Antibiotic Resistance
Department of Health: Antibiotic Resistance poses alarming threats
Antibiotics 101-Melissa Conrad MD
Royal Pharmaceuticals of Great Britain