Antibiotics - Boon or bane for infection treatment

“The deadly infectious diseases are back- Rajnikant may die of ‘Supertubeculosis’ in 2030”, today’s news headline in Times of India. Multiple reasons are there today to think about the ‘world without Antibiotics’. Antibiotics have saved so many lives in last six decades and are rightly called ‘Magic Bullets’. Today antibiotics are like our ‘endangered species’ and if nothing is done to save, then we will soon enter into the ‘post-antibiotic era’. So yes, antibiotics are blessing for humankind if being used judiciously. And like every drug, antibiotics usage may also be associated with side effects. 

In pre-antibiotic era, many people died of infectious diseases like tuberculosis, cholera, pneumonia, diphtheria, syphilis, meningitis etc. But the big breakthrough came in late 19th century, when scientists started researching drugs for killing these disease causing bacteria. Scientists discovered ‘Magic Bullets’ which could do wonder by killing microbes just like bullets in wars. And ‘War’ against microbes started which identified microbes as villains & doctors as heroes. In 1942, Alexander Fleming discovered Penicillin which saved many soldiers during World War II and many lives subsequently. After that, we have witnessed discovery of many different classes of antibiotics in last three-four decades and they have done wonders by saving so many lives from infectious diseases. 

In 1968, the US surgeon general famously proclaimed: “the war against diseases has been won and soon we will close our books on infectious diseases”. This has gone terribly wrong in last two decades. Bacteria have started fighting back. They are smart enough to change themselves for survival against antibiotics. And by doing so, they have reminded us that they have come first in this world and they know the art of survival. Nowadays, bacteria become resistance to available antibiotics. Future of antibiotics is dark due to several reasons. 

Today, antimicrobial resistance is a global public health issue. Our ‘Magic Bullets’ are losing the healing aura. Many patients die due to multi-drug resistance organisms. This problem is not limited only to the hospital-acquired infections but it has reached to community level as well. For example, community-acquired methicillin-resistance S. aureus (MRSA) is increasing and more dangerous. Infections due to multi-drug resistance organisms lead to increase financial burden on individuals and government. Billions of dollars are spent for new drug discovery but because of resistance catching up fast, pharmaceutical companies are not investing into researching new antibiotic. Unfortunately, antibiotic pipeline is scarce. No new antibiotic, effective against gram negative bacteria has hit the market in last ten years and not going to come in next 10 years. The problem of ‘Antibiotic Resistance’ is as hot as ‘Global Warming’. And world is approaching towards ‘Post-antibiotic Era’. 

 Antibiotic resistance has become the ‘tragedy of commons’ in India. India is a global leader in antibiotic resistance. Gram negative bacterial infections are more prevalent in India, in contrast to gram positive in western world. We have the highest rate of extended spectrum B-lactamase (ESBL) Enterobacteriaceae in India which is close to 80% in hospital-acquired infections and 40% in community-acquired. Infections due to ESBLs are resistance to cephalosporin and fluroquinolone classes which were being used as workhorse antibiotics earlier. In a recent study, carbapenemase is exclusive from India in Asia-Pacific which is resistance to the last class of antibiotic, Carbapenem. Total drug resistance tuberculosis has become prevalent now. There are number of reasons for very high rate of resistance in India like irrational usage, rudimentary antibiotic protocols, less number of specialists, inferior quality generics, flaws into regulatory and government policies, accountability and knowledge problems among Medical Writing fraternity, over the counter usage, animal usage, non-restricted market, influence from pharmaceutical companies, lack of research etc. Effort towards solving these is still lacking which is the biggest worry for us.

In conclusion, antibiotics are boon for humankind. Unfortunately, we are losing this valuable and hard earned resource. Irrational usage that has led to resistance is bane rather than side effects associated with life-saving antibiotics. Attempts should be made towards solving the above mentioned problems and researching new antibiotics soon.

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