A matter of staying on course

Antimicrobial drug resistance is a serious issue—why aren’t we talking about it? A matter of staying on course

Sushan Dhakal

Published at : December 30, 2018

Updated at : December 30, 2018 09:09

The concept of resistance is not new. Any system that undergoes pressure eventually retaliates. Retaliation can manifest in various forms. In the microbial world, it manifests in resistance. But if all-natural systems show retaliation of some sort in the long-run, why is microbial drug resistance the talk of the medical community even though it looks natural?

When Alexander Fleming discovered Penicillin for the first time in the 1920s, it was a silver bullet. In layman’s terms, penicillin is the most primitive form of the modern-day antibiotic. The science of the mode of action of antibiotic follows complex pathways but what it ultimately does is quite simple: it kills bacteria. But, reiterating my point, any system under pressure retaliates. The retaliation is a product of the emergence of a resistant variant of the same species of bacteria. A colony of bacteria, just like any other group of living organisms, has a group of strong individuals (the resistant ones) and a group of the average individuals (the susceptible ones). The antibiotic attacks the colony and generally wipes out the average-susceptible population immediately. The resistant ones however, find a way to survive. These resistant ones have the same ability to reproduce and spread just like the regular variant. If the same individual who caught the weaker variant the first time around catches the resistant variant the next time, the same antibiotic will not be effective against it. A more potent and new antibiotic has to be used to get rid of the same infection. The cycle repeats every time.

If a new potent antibiotic will always be able to find a way to get the job done, why stress about the resistant variant? Well, as it turns out, we only have a limited number of antibiotics with us. The rate at which new antibiotics develop is much slower than the rate at which these bacteria develop resistance. Some strains of bacteria like the Mycobacterium Tuberculosis—that causes TB—is multiple drug resistant, meaning a carefully moderated dose of the best available antibiotic might still not be able to kill the bacteria completely. These are called MDR-TB (multiple drug resistant TB) and recent research has also identified XDR (Extremely Drug Resistance) that are so resistant that they don’t respond to any antibiotic. Everything feels natural till now. There is a disease, there is a bacterium that causes that disease-, there is an antibiotic that is effective against this bacterium, and eventually there’s a development of resistance which yields a new strain of bacteria. So, where do we, as people, get a say?

Drug-resistance as the name suggests, is quite literally resistance developed to a drug. If you have a chest infection, the doctor prescribes a five-day dose of Azithromycin, a common antibiotic, which is expected to be taken three times a day. If the infection is Streptococcal (Streptococcus is a type a bacteria), the antibiotic wipes out the bacterial colony in five days given you follow the three times a day rule. After the first nine antibiotic capsule enters the system, the symptoms of malaise and fever disappear, giving the person a sense of false relief. What actually happens is: the antibiotic has already taken hold of the infecting organism and is killing them causing the symptoms that appear on the outside to subside. This is where the biggest mistake is made. People discontinue the course thinking that the infection is completely over but the most resistant variants that fought the initial bout of antibiotic live on and stay dormant until another opportunity to infect presents itself. But this time, the infection is caused by the stronger and more potent strain and it won’t be affected as easily by the regular does of antibiotic—it might require a stronger antibiotic or a longer dose of the same antibiotic. Either way it is deleterious for the human body. If you at least complete the course this time, and wipe the infection, the ordeal was at least worth it. But people rarely complete the course again and the next infection will require a larger antibiotic dose. Eventually there comes a point in this cycle where the infection cannot be cured by any antibiotic for any dose. What next? Well, if you are thinking that this won’t happen anytime soon, it already has. MRSA (Methicillin Resistant Staphylococcus Aureus) is a superbug in today’s world. You will be lucky to survive through an infection by this organism and this is just one of the millions of pathogenic bacteria that exist. In the worst-case scenario, if all of the pathogens develop resistance to all antibiotics, the fate of the human civilization is in serious jeopardy.

The situation is dire but just like climate change, very few believe that this catastrophe will happen in their lifetime. People need to understand that it has already begun, and it will get worse. Now, it is just about damage control. The simplest way to make a difference is to complete the course of antibiotic that the doctor prescribes for you. To go one step further, always consult a doctor and get the antibiotic you need instead of buying antibiotics over the counter. Although, not always feasible, the next best step is to get an antimicrobial drug resistance test done for all infections that you get.

The least, however, that you can do is at least spread the word and talk about it—to everyone you know. By promoting further discussion, maybe some people will understand and maybe more will take preventive steps.

Dhakal holds an Msc in microbiology