Antibiotic Resistance: Initiatives need to be taken to save future generations

"I have to go away; as long as there is life in my body

I will remove earth's trash with all of my existence

I will make the world livable for the babies before I leave

This is my firm commitment to each newborn"

I got inspiration from this poem 'Chharpatra' by Sukanta Bhattacharya and I have been working for last 20 years to make this world habitable for newborns. But I do not know how successful my effort will be at the end of the day, because the world now-a-days has been marred with severe calamities. We have eaten up resources of our future generations without their permission in ignorance and negligence. Antibiotics have been losing effectiveness because of their indiscriminate use and our carelessness and callousness. 70 years ago our ancestors lost battle against bacteria because of a lack of antibiotics. That tragic and helpless era is about to come back again. The difference is that our paternal and maternal grandparents succumbed to minor injuries in those days in absence of antibiotics. And our grandchildren will have numerous antibiotics on their shelves, but they too will die helplessly, because those antibiotics will no longer be able to kill harmful bacteria. This helpless condition is called antibiotic resistance.

Resistance developed by germs means loss of effectiveness of antibiotics. Almost all drugs have lost their effectiveness. Losing the effectiveness of antibiotics is different compared to other drugs. Other drugs simply lose their function in individual's body or become ineffective at one stage. But the difference regarding excessive use of antibiotics is that a few germs have changed their patterns. Because of the frequent application of antibiotics against germs, at one stage a few bacteria have grown an ability to survive against antibiotics.

The surviving bacteria have come up with new methods to fight back antibiotic. Consequently, the drugs are no longer effective against them. We call these microbes as antibiotic resistance microbial and the crisis as antimicrobial resistance (AMR). When certain bacteria cannot be killed with certain drugs, in medical science we say that they have become resistant to antibiotic.  We cannot see bacteria, we can see people infected with antibiotic resistant bacteria. Because of that we think that man has become resistant to antibiotics. That is not the case at all. The bacteria that the man was infected with have become resistant. A human-body never reached a status of resistant to antibiotics. But bacteria might develop resistance.

Around 70-80 years ago, people around the world died of bacterial infection caused by common cold, cough, fever and any minor injury, because antibiotics were not discovered then. As a result, human race did not have control over common diseases. People were helpless against bacteria. People of the world have enjoyed a kind of hilarious victory over bacteria for the last 50-60 years after penicillin and various other antibiotics were discovered. Consequently, the operations are now-a-days carried out successfully as well as the cancer patients are being treated well. But when the drugs have been losing their effectiveness due to resistance developed by germs, people are going back to an era where there was no antibiotic.

No new antibiotics have been discovered in the last 20 years. If we cannot discover a good number of antibiotics in the next 5-7 years, then the people of the world will again lose the battle against bacteria as they did in the past. No one is safe from this risk. Even the president of America or a man in the deepest jungles of Africa is in risk, because bacteria do not recognise any human. When a resistant bacterium attacks, everyone is under equal risk.

Now the only solution is to develop effective antibiotics for people who have been suffering from resistant bacteria. But a stagnated situation is prevailing over the world regarding the discovery of effective antibiotics. At best one or two antibiotics will have to be discovered in the next 6-7 years. In such a crucial situation we have to use the weapons we have in our hands carefully. It has to be used in a way similar to playing a game of 'hide and seek'. It seems that a kind of bacteria was killed by hitting on their heads. Now such germs have learned to withstand by wearing helmets. Now we have to kill those bacteria with a drug that hit their stomach. Again, when those germs will learn to wear leather belts in their abdomen, we must learn to hit their backs to kill them. We can continue killing such bacteria for another seven to ten years if we will apply cautiously such hide and seek methods. We must use these weapons with utmost care and intelligence, until the discovery of new antibiotics. Only then treatments against germs will be effective. Otherwise, we will have to die helplessly. Now, we have found that 20 to 40 percent of people are infected with bacteria where no antibiotic is effective in the ICUs of our hospitals. In such dire situation, physicians have no choice but to sit helplessly. Now-a-days, such phenomenon may be limited to a small number of people – patients only in the ICUs – but it will become a common scenario sometimes later.

The antibiotics are gradually losing effectiveness as people are administering drugs unnecessarily and indiscriminately, breaching rules of prescription. Moreover they stop taking them before completing the course. There are 2.3 lakh drug stores in our country. If two people bought antibiotics from each store every day, then a staggering number of around five lakh antibiotics is being sold out in a single day. People need to be aware of the dire consequence of the misuse and overdose of antibiotics. Many people do not complete the antibiotic course to save only Tk200 which ultimately withstand the respective germs. They fully disregard the fact that upcoming generations will suffer in the near future. If we do not consider the situation carefully, then the crisis will not change. It is mandatory to follow the antibiotic dose rules. Trice in a day means three times in single day and exactly after eight-hour interval. We take doses of antibiotics in the morning, at noon and at night, which is not fair. A patient must follow the rules for Eight days or ten days or as long as the doctor prescribe him to take antibiotic.

The side effects of sleeping pills or other drugs are usually limited to individuals only. But the impact of antibiotics is widespread. If antibiotics do not work, then not just individuals but the health of future generations will be at risk. Only spreading such awareness among the mass people can help to protect the world.

Around 50 to 60 thousand doctors are practicing in the country. There are around four lakh non-qualified prescribers, including quacks and substandard doctors illegally practicing along with them. Those quacks usually give unnecessary antibiotics. We have to control them strictly.

In addition, doctors have a tendency to prescribe antibiotics unnecessarily for viral fever. There is a tendency among physicians to prescribe antibiotics for over 10 to 15 days if patients need antibiotics for only one or two days after an operation. The doctors must set examples by behaving responsibly. People always want to abide by the doctors' instructions regarding treatment. Doctors have to tell people that antibiotic poses risk for patients also.

Besides, medicine manufacturers, regulatory bodies and common people will decide whose advice needs to be followed while taking drugs. And the state has to play a role as regulator. Authorities concerned have to legislate a law to prohibit selling of antibiotics without a prescription and implement it strictly. The law should specify punishments for breaking the law.

The relationship between awareness and profit is different. Thousands of people of pharmaceutical companies are working to speed up sales and promotion of antibiotics every day. For making more profit, a huge pressure is prevalent everywhere to sell out expensive antibiotics in huge amount. This pressure is widespread over physicians, medicine sellers and upon all the people. The state and the authorities should take measures to subjugate this illegal pressure.

To raise awareness among people over the rampant use of antibiotics, red color should be applied over the wrappers and packaging box of antibiotics. The term "Antibiotic" should be printed in Bengali, so that people can easily distinguish antibiotics from the rest of the drugs. The full course of antibiotics should be marketed in a single package which will check retail sell. At the same time, it must be ensured that, people will finish the course. A chapter on antibiotic resistance should be included in the textbook, so that students will learn about it from a young age and inform their family.

In order to save future generations from antibiotic resistance, effective steps must be taken now without using the reserve antibiotics. Will you ignore the warnings of ordinary sailors like the captain and engineer of the Titanic did? Do you also engage in seminars and conferences? The decision is yours.

Professor MD Sayedur Rahman, Chairman, Department of Pharmacology, Bangabandhu Sheikh Mujib Medical University (BSMMU).