Resisting the cure

Antibiotics are one of the world’s mostly commonly prescribed type of drug, but what happens when they are excessively used? Priya Kulasagaran learns the extent of the problem of antibiotics resistance

A few months ago, a conference by the American Society for Microbiology reported a rather alarming find: a bacteria with the gene called mcr-1 has been spreading worldwide at a rapid rate. This gene enables bacteria to be resistant to the antibiotic colistin, and was first discovered less than two years ago. Now, it seems to be far too common: in one part of China, 25% patients in hospitals had the gene. The mcr-1 gene has already been detected in Malaysia as well.

Developed in the 1950s, colistin was initially more commonly used for animals as it caused adverse side-effects in humans. Over time however, as more patients failed to respond to other types of antibiotics, colistin has become part of the “last resort” arsenal of doctors. While other stronger antibiotics still available, having a life-saving drug becoming near useless against resistant bacteria does not bode well.

Researchers estimate that some 700,000 people a year die from drug-resistant infections; this number could reach 10 million by 2050. The danger here is that many aspects of modern medicine cannot be carried out effectively in a drug-resistant world. In transplant surgery for example, a patient’s immune system has to be suppressed to prevent their body from rejecting the new organ. This leaves the patient vulnerable to infections; without antibiotics, such infections could be life-threatening.

What is antibiotics resistance?

Antibiotics resistance occurs when certain bacteria changes its responses to being exposed to antibiotics. It is the bacteria, not the persons or animals receiving the antibiotic, that become antibiotic-resistant. When we get infected by these “evolved” bacteria again, the infections they cause can become harder to treat.

The World Health Organisation (WHO) last year published a list of bacteria which need new antibiotics. The list of antibiotic-resistant “priority pathogens” is made up of 12 families of bacteria, including those which can cause severe conditions such as bloodstream infections and pneumonia. Some of these bacteria have been shown to be resistant to various types of antibiotics, almost as if they have a developed shields against the drugs.

Reading through the literature on antibiotic-resistance, it sounds like we are heading for a dystopian diseased-filled future. But just how serious can the problem really be? After all, scientists seem to be developing newer antibiotics to combat resistance all the time – just last March, researchers from Yale University made news for a “superantibiotic” called vancomycin 3.0, said to be 25,000 times more potent against certain types of bacteria.

“Trust me, it is definitely a very real and serious threat — the data shows this, and doctors and scientists have been sounding the alarm bells for years,” says Datuk Dr Christopher Lee, head of infectious disease at Sungai Buloh Hospital. “This is why we’ve been tracking antibiotic use and resistance at our public health facilities, and the results are a cause for concern. We know we have the mcr-1 gene here, and we’re recording an increasing number of patients who are not responding to the usual antibiotics.”

He explains that one of the major reasons for resistant bacteria is the excessive use of antibiotics. “For example, when people just pop antibiotics if they have a cold or a sore throat; most of the times, these are caused by viruses not bacteria, so the antibiotic is of no use. And even when it is caused by bacteria, more often than not, your body is able to fight it off without the need for antibiotics,” he says.

Antibiotic-resistant bacteria can also be found in animals, as well as the environment like in water, soil and air. These bacteria can enter the human body when the meat is consumed, or if you’re exposed to surroundings that play host to them.

In India and China, where a large proportion of antibiotics are produced, the poorly regulated discharge of untreated wastewater into soils and rivers is causing the spread of antibiotic ingredients which cause bacteria to develop immunity to antibiotics, creating superbugs. One study of wastewater factories in China found that for every bacterium that entered one waste treatment plant, four or five antibiotic-resistant bacteria were released into the water system, tainting water, livestock and communities.

The Malaysian love for antibiotics

The Health Ministry has repeatedly voiced its concerns over antibiotic misuse, citing increases of uncontrolled usage of antibiotics among patients, both prescribed and over-the counter. In the National Surveillance of Antibiotic Resistance Report 2015, data obtained from 39 hospital microbiology laboratories showed that we have almost every variety of antibiotic resistance thus far documented.

Another study, carried out by University Sains Malaysia, published in 2015 found even more disturbing attitudes among general practitioners regarding antibiotics. Surveying  139 private care physicians treating urinary tract infections, researchers found that over 80% of doctors could have reduced the dosage of antibiotics prescribed by one-fourths. Some 36% of doctors believed that their patients will seek medical help elsewhere if they were not given antibiotics, and 21% prescribed antibiotics even when they felt they were unnecessary. Interestingly, 3% admitted that they prescribed antibiotics for financial benefit.

While the Health Ministry monitors antibiotic usage and resistance rates in government and university hospitals, there are no such mechanisms in place in the private sector. “The larger private hospitals aside, it is the vast number of private clinics that we have no monitoring process for,” says Dr Lee. “What we’re trying to do now is to educate both doctors and patients on the dangers of misusing antibiotics.”

He adds that patients in particular need be better educated about how antibiotics work, and not see them as cure-all wonder drugs. “It’s very common for patients to ask or even insist on getting antibiotics. But if we keep going down this route, without any intervention, the consequences can be very dire for everyone.

What you can do

Sungai Buloh Hospital’s Infectious Disease Physician Dr Benedict Sim offers some helpful tips on how patients can help combat antibiotic resistance.

  1. Preventing infections in the first place

This means all the rules of good hygiene apply, like washing your hands after going to the restroom and avoiding sharing utensils with those who are ill. Dr Sim says that more people should also keep “cough etiquette” in mind: always cover your mouth and nose when coughing or sneezing to prevent those germs from spreading to others.

  1. Don’t use leftover antibiotics

Aside from possibly being past their expiry date, the leftover drugs may also do nothing for your current ailment. “I know of people who use their family member’s unfinished antibiotics, and we strongly advise against doing this,” adds Dr Sim. “At worse, someone else’s antibiotics — prescribed specifically for their illness — may cause adverse reactions for you.”

  1. Don’t buy antibiotics over the counter

Not only is it illegal in Malaysia to purchase antibiotics without a doctor’s prescription, self-medicating this way will also likely do little to heal you and further contributes to the growth of resistant bacteria.

  1. Always consult a medical professional

If you’re not getting any better, a visit to the doctor should be on the cards. “If the doctor says that you don’t need antibiotics, they are probably right,” says Dr Sim. “But if you want better explanations, or if you feel like you’ve been unnecessarily prescribed antibiotics, do discuss it with your doctor.”

When do you need antibiotics?

Antibiotics will only work bacterial infections, not viral ones. This means infections such as colds and the flu, usually caused by viruses, will not respond to antibiotics. While you should always consult a doctor to determine your illness, here is a rough guide on when antibiotics are useful for common illnesses.

Illness/ Symptoms

Likely cause

Do I need

antibiotics?

Virus

Bacteria

Cold/ Runny nose

O

NO

Bronchitis

O

NO

Whopping cough

O

YES

Flu

O

NO

Strep throat

O

YES

Sore throat (aside from strep)

O

NO

Urinary tract infection (UTI)

O

YES

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