How safe are your antibiotics?

"When I woke up just after dawn on September 28, 1928, I certainly didn't plan to revolutionise all medicine by discovering the world's first antibiotic, or bacteria killer,” Sir Alexander Fleming would later say famously, “But I suppose that was exactly what I did.”

A Scottish biologist, botanist and pharmacologist, Sir Fleming is best known for his discovery of lysozyme (an enzyme occurring naturally in egg white, human tears, saliva, and other body fluids, capable of destroying certain bacteria and thereby acting as a mild antiseptic) in 1923 and the antibiotic substance benzylpenicillin (Penicillin G) in 1928, for which he won Nobel Prize in medicine in 1945.

Discoveries of more antibiotics followed. The result was spectacular success in combating infectious diseases like pneumonia, tuberculosis, sinus infections, strep throat and urinary tract infections. During the past seven decades, antibiotics or antimicrobial agents played a critical role in reducing the burden of communicable diseases throughout the world.

However, what came as a blessing turned a devil in disguise, not in itself but in the wide and indiscriminate use of common antibacterial drugs.

This has contributed substantially to the development of resistance of infections, meaning many antibiotics, even the most advanced ones, don't work against some common pathogens anymore. Some other bacteria are resistant to all antibiotics available. The result this time is treatment failure, causing morbidity, mortality and economic loss, according to the World Health Organisation.

In his Nobel Prize speech, Fleming warned of this consequence. Ironically today, his Penicillin Group antibiotics have come to prove ineffective for up to 90 percent cases of hospital-acquired infections or surgery-related wounds. Also, ciprofloxacin, an antibiotic that has been used globally to treat typhoid for decades, is not that effective anymore.

A recent forecast provides an estimate of 10 million deaths per year and a global gross domestic product 2-3.5 percent less than it otherwise would be by 2050, if antimicrobial resistance (AMR) continues to rise, according to the WHO.

'VERY ALARMING'

In Southeast Asia Region of the global health body, resistance against most of the key pathogens that cause infections in hospitals and communities is widely prevalent.

In Thailand, for example, hospital-acquired infections by multidrug-resistant bacteria cause around 30,000 deaths a year. And the annual cost due to antibiotic-resistant infections was estimated to be about $2 billion, WHO documents show.

"It is very, very alarming. Many patients die in Bangladesh from hospital-acquired wounds because some antibiotics have just stopped working," said Prof AKM Shamsuzzaman, director of Communicable Diseases Control at the Directorate General of Health Services (DGHS).

There is no concrete data on casualties, and he suggested that the government conduct a research in this regard.

In India, Pakistan, Afghanistan, Nepal and Bangladesh, one child dies in every five minutes because the antibiotics are ineffective due to bacterial resistance, a study shows.

In Bangladesh, rural people are particularly exposed to serious health problems, including damage of liver and kidney, because of indiscriminate intake of antibiotics, states the research published in the Science Domain International, a UK-based journal, on January 15 this year.

It found 44 percent doctors prescribe antibiotics for cold, fever and acute respiratory infections without diagnosis, a mandatory procedure according to WHO guidelines.

The study was conducted among 6,000 patients, 580 physicians, village doctors and pharmacists in the rural areas of Dhaka and Rajshahi divisions between July and December 2012.

BRIBING THE DOCTORS

Kumar Bishwajit Sutradhar, one of the researchers and a senior lecturer of pharmacy at Stamford University in Dhaka, told The Daily Star early this year that drug companies bribe a section of doctors in cash or kind to to prescribe antibiotics.

"This is true," Prof Shamsuzzaman said, citing his experience. "It's because the medicine companies want to increase their sale. But things are particularly worrying in rural areas, where representatives of medical companies can easily influence the pharmacy owners or salesmen."

Patients, on the other hand, are often careless. The study found almost 50 percent of them stop taking the prescribed antibiotics the moment the symptoms of illness disappear, and 27 percent think it's not always important to follow prescriptions.

However, the next time they contract the disease, they need double the dose because the bacteria, which were supposed to have been killed or kept from reproducing, has instead grown stronger by this time.

POST-ANTIBIOTIC ERA

The AMR issue is extremely complicated and therefore difficult to deal with because it involves biological, technical, behavioural and regulatory matters. But a strong guideline on the use of antibiotics can be a big first step to address the threat, said Dr Be-Nazir Ahmed, professor of microbiology and head of parasitology at the National Institute of Preventive and Social Medicine.

WHO experts echoed his view at a roundtable with journalists from the member states of its Southeast Asia Region in Dili, the capital of Timor-Leste, yesterday.

"If urgent and comprehensive steps are not taken to combat antimicrobial resistance (AMR), the world shall slip into a 'post-antibiotic era' where mortality and morbidity due to infectious diseases shall be at par with those that were seen in the 'pre-antibiotic era'," the WHO warns.