Antibiotics – Stop indiscriminate use, save them for generations to come
“Arguably the greatest risk…to human health comes in the form of antibiotic-resistant bacteria. We live in a bacterial world where we will never be able to stay ahead of the mutation curve. A test of our resilience is how far behind the curve we allow ourselves to fall.” – (Howell L, ed. World Economic Forum, 2013)
Q: What is an infection?
Infection is the invasion of the body tissues by an army of microorganisms – viruses, bacteria, fungi or parasites. We have billions of bacteria residing in our body, on our skin surface, in our mouth, gut and urinary tract. They are not harmful till the time they invade our body.
Q: What is an antibiotic?
Antibiotics are a class of drug that either kill or stop production of bacteriae and help our body combating a particular infection. Most of these classes of drugs are actually produced in the nature by fungi or they derivatives of naturally available substances. Antibiotics have no effect on viruses, fungi or parasites.
Q: Do we have any drugs against viruses or fungi or parasites?
Yes we have but they are only few in numbers. For example, we have effective treatment against malarial infection or against amebiasis. Anti-viral drugs are limited in numbers and they are not as efficacious as an antibiotic against a particular bacterium.
Q: Why not we kill all the bacteria?
Bacteriae and other microorganisms exist in this world much before the existence of mankind. They are much larger in number and smarter then us – propagating much faster then us (imagine a bacteria producing millions of offspring in few minutes time compared to human being producing two or three in their lifetime!). Capability of genetic mutation and thus escaping disaster are much better in microorganism then us. We cannot eliminate them at all, can only co-exist with them.
Some microorganisms are actually good for our existence. They protect us from invasion by more harmful bacterial army. Imagine what will happen if these friendly microorganisms are eliminated!
Q: Do we need antibiotic for all fever?
No. Fever is the body’s natural response to injury. Injury may be caused by infection or else due to noninfectious processes like trauma or burn or pancreatitis. Fever may be because of direct injury to body’s temperature regulating center in the hypothalamus of brain e.g. due to stroke or head trauma. Antibiotics may help only in those infectious processes due to bacterial infection. A large no of common infections are not due to bacterial invasion. For example, common infections like running nose or loose motion or throat pain are mostly due to viruses and antibiotics have no effect on them. “ANTIBIOTICS CAN ONLY HELP IN TREATING BACTERIAL INFECTION NOT FEVER”.
Q: Do we need an antibiotic for wound healing?
No. Antibiotics can treat an infected wound and all wounds are not infected. We should try to keep the wound clean by applying sterile dressing. Antibiotics neither help in wound healing nor help in preventing wound infection.
Q: Can we use antibiotics to prevent infection?
No. Antibiotics are not magic bullets. A particular antibiotic is useful only against a handful of bacteria not against all bacteriae and they are not useful in preventing infection. But a short course (for less then 24 hours) of antibiotic is used sometimes to prevent invasion by a particular bacteria peri-operatively starting just before the incision. This is called surgical prophylaxis, but using this prophylactic antibiotic for longer then 24 hours does not help the patient. Rather prolonged antibiotic prophylaxis may be harmful – promote bacterial resistance and invasion by a more resistant organism!
Q: How can we prevent infection?
We can prevent infection by maintaining cleanliness of our surroundings, public health measures like clean water, sanitation, personal hygiene and vaccination. Vaccination is not only useful in childhood but also useful in elderly. Adult vaccination is now promoted to prevent certain common and potentially life-threatening lung infection like influenza and pneumococcal lung infection.
Q: What is antibiotic resistance?
Because of their great mutability bacteriae develop resistance to antibiotics to which they were previously sensitive. Some bacteriae are inherently resistant to a particular class of antibiotic and some develop resistance against them after prolonged use.
Q: How an antibiotic resistance develops?
Antibiotics can only kill sensitive bacteria. Unnecessary prolonged antibiotic use not only kill the bacteria against whom it is intended to be used but also those bacteriae that are only bystanders. This lead to overgrowth of bacteria against whom this particular antibiotics have no effect leading to subsequent infection by a resistance organism. This mechanism of antibiotic resistance is called collateral damage. Another mechanism of bacterial resistance against antibiotic is selection pressure where prolonged antibiotic use lead to selection of genetically stronger bacterial clone to progress.
Q: How can antibiotic resistance be prevented?
1. Use antibiotics only against life-threatening bacterial infection not against some viral infections.
2. Use all means to identify causative bacterial infection including culturing the bacteria. They help in identifying bacteria and using specific antibiotic against them.
3. Remove source of infection like draining the pus.
4. Limit the duration of antibiotic use. In general antibiotics kill the bacteria after 4-8 days of use. Fever may persist even after the bacteria are killed.
Q: How can we as a society rise against the menace of antibiotic resistance?
1. Stop using over the counter medication.
2. Say no to pharmacist dispensing antibiotics without prescription, not even the antibiotic ointments.
3. Ask for a valid prescription from your doctor.
4. If an antibiotic is prescribed, you have the right to ask your doctor – Why? What type of infection – urine, lung or abdomen or any other site? How long?
5. Make sure adequate cultures are being sent before use of antibiotics. It is worth spending your money in cultures rather spending the same money on unnecessary antibiotics.
6. Stop using antibiotics from dubious manufacturers. It is worth spending money on quality antibiotics from reputed manufacturers.
“LET’S TAKE THE PLEDGE”
Antibiotics have saved more human lives then all other medical intervention combined. Let’s pass on the benefit to our next generation. Let’s fight the antibiotic resistance together as a society. Let’s not go back to pre-antibiotic era.
Our children have the right for “CLEAN WATER”, “CLEAN AIR”, “CLEAN FUEL” and “ANTIBIOTICS”
Pre-antibiotic Era Photograph (Circa 1895) – A child dying of pneumonia family and friends have no alternative but to just pray to god.
Pre-antibiotic Era Photograph (Circa 1855) – Doctor treating lung flame with some dubious method.