Will antibiotics kill us?

A terrible news has recently been sparked in Bangladesh. According to a recent report, 52 per cent Intensive Care Unit (ICU) patients at Bangabandhu Sheikh Mujib Medical University (BSMMU) have been suffering from antibiotic-resistance.

The news is undoubtedly one of the biggest concerns in public health and linked to global problems as the rise of antibiotic resistance (ABR) against pathogenic bacteria has been causing untreatable infections.

Bacterial pathogens have been a vital cause of hundreds of diseases. Antibiotics have been considered one of the biggest weapons for fighting these diseases. Since the development of antibiotics in 1928, it has been used as a key medicine against bacterial/ fungal infections.

Antibiotic resistance is responsible for around 700,000 deaths annually around the globe. By 2050 it would be a major cause of up to 10 million deaths annually. Therefore, how antibiotic resistance evolves and spreads is a key health issue of the world.

Just after a decade of the discovery of Penicillin and, subsequently, and the emergence of a group of antibiotics, several scientists, including Gladys L Hobby and Bigger JW said that a small number of microbial organisms like bacteria could survive intensive antibiotic treatments to patients.

Generally, the association with the failure of antibiotic treatment and the relapse of many bacterial infections is called antibiotic tolerance. That means bacteria could grow slowly at a high concentration of antibiotic drugs.

On the other hand, the inherent ability of microorganisms to grow at high concentrations of an antibiotic is called antibiotic resistance. In that case, the sustainability of a certain bacteria might be prolonged and a higher concentration of the antibiotic might be required to cure the infections. The antibiotic resistance not just helps the bacteria to survive the presence of the drug but also enables them to replicate faster.

However, there is a debate between antibiotic persistence and antibiotic resistance. I prefer to use antibiotic persistence rather than resistance. Because the persistence of the infection is not depended on antibiotics but also relies on other factors.

Usually we think that if the antibiotic does not work to the patient's body, it means that the prolongation of infectious diseases is caused by the rejection of drugs. But this is not exactly true. There are several factors such as stress conditions, limitation of different nutrients of microbes, immune factors that are induced to the persistent microbes. In addition, environmental factors such as climate, temperature, and even bacteria in the host's body can become tolerant.

Therefore, the word "persistence" might be suitable than the antibiotic resistance. 

Now, come to the moot point, have you ever taken antibiotics without the prescriptions of doctors? Have you ever purchased your medicine in the grocery? How many times did you fail to complete the dose of antibiotics?

I think in a developing country like Bangladesh a large number of people can buy their drugs without the prescriptions of registered doctors from unregistered pharmacies.

The way we consume drugs is only possible in very few countries around the world. If we have a sneeze, we often think it will be more beneficial to cure it within a second. And this practice is pushing us close to death. Neither the doctors, patients, pharmacists or pharmaceutical companies are concerned about this malpractice.

You have no idea how difficult it is to get a simple medicine such as paracetamol in abroad. Without the prescriptions from registered doctors, you are not allowed to buy a single medicine from the drug stores.

Look, if pneumonia or urinary tract infections are no longer cured by conventional medicine, can you survive?

Most of our hospitals are not hygienic for proper treatment. It appears that many patients return home from the hospital with antibiotic tolerant bacteria.

Doctors and staffs are not always aware enough to maintain hygiene while treating the patients.

The people in Bangladesh are not interested to consult with an infectious disease specialist in order to optimise antimicrobial agent selection.

Pharmaceutical companies are selling drugs especially antibiotics without any proper management. Both the companies and drug sellers regulate the market to earn more profit.

Not only that, the responsibility of regulating the quality of medicines is not properly maintained in our country. You may be surprised to see the concentration of drugs (mg) are quite higher here than the developed countries. That means we are enough in antibiotic persistence at a low concentration of doses.

In addition, a generic drug is usually interchangeable with an innovator product, which is marketed by many companies without a license, those are more dangerous for antibiotic persistence.

Most of the pharmaceutical companies neglect the research and development process of studying antibiotics in our country.

I hope government policy-makers should demand more transparency and expand existing production standards to incorporate and enforce environmental protection issues.

We have to draw the attention of the world leaders to stop the increase of antimicrobial resistance with the urgency of acting swiftly against antibiotics.
 
It is never acceptable to sell and consume antibiotics without the prescription of doctors.
If we fail to implement the laws right now, people will die of very common diseases in Bangladesh. You will die of tuberculosis or inflammation of the lungs. The reason is antibiotic-tolerant bacteria, which are leaning towards us.

Just keep in mind, antibiotic pollution can disrupt environment-friendly bacteria and algae in water and soil. It has been reported that many antibiotic persistent bacteria are spread around the medical facilities.

Therefore, we need strict enforcement of drug laws to protect us. We believe one day researchers of our country will contribute in research and innovation concerning the crisis. We might be able to reduce bacterial persistence if we can ensure the proper use of antibiotics. We shall not let them sell a single antibiotic without prescription and stop buying drugs without registered pharmacies ourselves.

SM Nadim Mahmud, A PH.D. Candidate at Osaka University, Japan.