A new development in medicine where diseases caused by various types of microorganisms no longer respond to treatment with known drugs is setting the world on edge; and the very future of public health could soon be enfolded in uncertainty. Experts who are drawing attention to the situation and its consequences say the crisis has reached a tipping point, demanding an urgent global response to stem the tide and save lives.
The threat of antimicrobial resistance is already being compared to the current epidemic of cancer, one of the leading causes of morbidity and mortality in the world today. While cancer was implicated in the death of 8.8 million people in 2015, it is estimated that drug-resistant infections will kill 10 million people annually by 2050, up from the current 700,000, if something urgent is not done. This is not a fate reserved exclusively for the Third World countries, as usual; but a reality that currently stares the global audience in the face, says the World Health Organisation.
According to a recent publication by WHO, there are 12 different categories of bacteria that pose the greatest risk and demand a response with the introduction of new and efficacious antibiotics. They include a group that has become multidrug resistant and could cause severe and deadly bloodstream infections and pneumonia. Others are responsible for diseases as common as gonorrhoea or food poisoning. Some of the bacteria are Acinetobacter baumannii, which is carbapenem-resistant; Pseudomonas aeruginosa, also carbapenem-resistant; Enterobacteriaceae, carbapenem-resistant and ESBL-producing; and Enterococcus faecium, which is vancomycin-resistant.
Also listed are Staphylococcus aureus, which is methicilin-resistant, vancomycin-intermediate and resistant; Helicobacter pylori (clarithromycin-resistant); Campylobacter (fluoroquinolone-resistant); Salmonellae (fluoroquinolone-resistant); Neisseria gonorrhoeae (cephalosporin-resistant, fluoroquinolone-resistant); Streptococcus pneumoniae (penicillin-non-susceptible); Haemophilus influenza (ampicillin-resistant); and Shigella spp. (fluoroquinolone-resistant).
WHO says antimicrobial resistance occurs in situations where microorganisms such as bacteria, viruses, fungi and parasites stop an antimicrobial – such as antibiotics, antiviral and antimalarials – from working against them. The result is the ineffectiveness of standard treatments on simple infections, inevitably leading to longer periods of treatment and even death.
It is caused by overuse or misuse of antibiotics over time, forcing the microorganisms to undergo mutation of their genetic materials or develop pieces of DNA that codes for the resistance properties from other bacteria. Some people buy these antibiotics over the counter without any doctor’s prescription, which is very dangerous, while those with prescription do not bother to adhere strictly to the dosage.
The fears expressed may seem far-fetched, but they are already being manifested in diseases such as HIV and tuberculosis. The emergence of multidrug-resistant TB is causing avoidable deaths, with WHO putting the number of deaths in 2015 at 250,000. This is sad for a disease that was hitherto easily treatable. It is the same thing with HIV, where second line antiretroviral drugs are being employed after widespread resistance to first line drugs.
Having been born into a world made more secure by antibiotics, where, with the downing of some pills, sick people are able to overcome common infections, it is difficult to now imagine life without antibiotics. What is happening now is but a throwback to that era when medical science had to cope without the drugs to treat or prevent infections caused by bacteria, parasites, viruses and fungi. Then, every infectious disease that the immune system could not effectively deal with was almost inevitably a sentence to death. Life expectancy was short and maternal and infant mortality reached unprecedented heights.
For instance, it is on record that Bubonic Plague, an infectious disease caused by zoonotic bacteria, yersinia pestis, led to the death of estimated 50 million people, mostly in Asia, Africa and parts of Europe, in the 14th century. Small pox, another deadly disease, claimed more than 500 million lives, according to a CNN online report, before it was eradicated in 1979 through global vaccination. Syphilis and a host of other infectious diseases also proved veritable killers before the discovery of antibiotics.
However, with the current trend, common procedures usually taken for granted will now become very risky and deadly. As David Livermore of the Health Protection Agency, London, rightly said, “A lot of modern medicine would become impossible if we lose ability to treat infections.” Things like transplant surgery where patients’ immune systems would have to be suppressed to stop the rejection of new organs, exposing them to infection, or the use of immuno-suppressant cancer drugs would be impossible. When a doctor cannot safeguard patients from bacteria leaking into the body cavity, “far more people will die of peritonitis,” said the professor of Medical Microbiology.
Ideally, when some antibiotics lose their potency, there should be new ones to replace them. That the new ones are not forthcoming is the real reason for the current alarm bells. A report claimed that nearly all the antibiotics in use today were based on discoveries of 30 years ago. Antibiotics are not among the fast selling drugs and takes up to 10 years to come up with new ones that are safe for use on humans. It is therefore not something that pharmaceutical companies will be enthusiastic about investing in. This is why Marie-Paule Kieny, the WHO assistant Director General, said, “We are fast running out of treatment options.”
Since research into antibiotics has not proved to be a very profitable venture, it is important to heed the WHO call for governments to collaborate in funding research into discovering new antibiotics. As Kieny said, it is not something to be left to market forces. Philanthropists should also get on board.
In the meantime, it will be advisable for people to maintain a high level of hygiene so as to keep bacteria at bay. Hand washing should be compulsory after a visit to hospitals or toilets. Abuse of antibiotics should also be discouraged, especially the idea of walking up to a pharmacy and buying drugs that are not prescribed by a doctor. For those whom drugs are prescribed, they should endeavour to use as prescribed.
