Dr. Tahseen Mahmood Aslam talks about a rising problem
The advancement in scientific Antibiotics losing efficacy approach led to miraculous discoveries that revolutionized the way the human race lived its life. The first major breakthrough having extremely beneficial and far reaching consequences was mitigating and later eradicating pain that hitherto remained the bane of human existence. The other milestone was achieved when penicillin was discovered proving very capable in fighting external bodies making inroads into human body. Penicillin was the beginning of the phenomenon of antibodies considered very effective in fighting bacteria. Antibiotics was a novel way of treating the unhealthy affects of foreign bodies penetrating in human body through inducting bodies of same bacteria with chemical instruction to act friendly to human body and annihilate the enemy bodies. For the first time in the long history of human evolution this unique method of treatment swayed the balance in favour of humans and provided them with necessary wherewithal to stand up to fatal effects of bacterial infection.
The antibiotics were consequently fine-tuned and they were categorised as a large formation termed as antimicrobials, which includes medications to fight microorganisms such as bacteria, fungi and parasites. The large-scale production of antibiotics took place during the Second World War and it became instrumental in saving hundreds of thousands of human lives. Antibiotics in the war were the first commercially manufactured drug that proved very effective in treating wounds and ulcers. The rise of antibiotics saw around a hundred different kinds of antibiotics being processed and used. Medicinal science categorises antibiotics on their mechanism of action, chemical structure and spectrum of activity. The development of this treatment system is such that most antibiotics target bacterial functions or growth processes.
The broad categorisations of antibiotics include Penicillin and cephalosporins that attack the bacterial cell wall and break through it. Polymixins interfere with essential bacterial enzymes by attacking the cell membrane. Rifamycins, lipiarmycins, quinolones and sulfonamides possess bactericidal activities. In addition protein synthesis inhibitors such as macrolides, lincosamdies and tetracyclines are usually bacteriostatic. Antibiotics are further divided into area-wise functionality as “Narrow-spectrum” antibiotics target specific types of bacteria like gram-negative or gram-positive whereas broad-spectrum antibiotics affect a wide range of bacteria. The development in antibiotics stalled for a period of forty years and in the last decade only four new classes of antibiotics were brought into action for clinical prescriptions including cyclic lipopeptides, glycylcyclines, oxazolidinones and lipiarmycins.
Currently health care is heavily reliant on antibiotics as a common treatment of common bacterial infections, including strep throat, tuberculosis, urinary tract infections, and some sexually transmitted infections. Antibiotics also provide competent assistance to patients with acute immune systems disorders due to cancer treatment or major surgery. Scientists were always conscious of the level of resistance that bacterial substances were expected to launch against the pervasive tide of antibiotics. The resistance has accordingly been experienced and often reflects evolutionary processes that take place during antibiotic therapy. The antibiotic treatment may encounter bacterial strains with physiologically or genetically enhanced capacity to survive high doses of antibiotics. Under certain conditions it may result in preferential growth of resistant bacteria while growth of susceptible bacteria is inhibited by the drug.
Faced with strong resistance of bacteria, antibiotics are actually on the verge of facing an existential threat less than a century since they came into play. Antibiotics are consequently proving less potent owing to frequent use by humans. The spectre of antibiotics failing to treat bacterial diseases is fast staring researchers in face. It is estimated that drug-resistant bacteria is causing seven hundred thousand deaths a year currently and is predicted to rocket up to millions in about a quarter of a century. International health agencies and governments of developed world are pouring billions of dollars to handle this looming threat.
It is quite obvious that like all living organisms bacteria too adapt and evolve according to the environment they breed into and exist. It is also very natural to find out that bacteria develop defenses against antibiotics and develop the capability to survive the onslaught of antibiotics. They are found not only to survive but are also found to be reproducing and spreading. The growth of drug-resistant bacteria is calculated to equal the development in antibiotic treatment.
Adding to the problem is the exorbitant use of antibiotics globally. It is often estimated that tens of billions of antibiotic doses are used for treatment in the world and unfortunately a great deal of them are prescribed to patients with viruses or other illnesses that do not respond to antibiotics. In countries like Pakistan the problem is confounded due to lack of effective control of using medication as antibiotics could be easily bought over the counter without a prescription from a doctor. The excessive use of antibiotics for curing animals actually contributes to the spread of resistant bacteria that are easily transmitted from animals to humans through the food chain and in more indirect ways.
Doctors and researchers have become increasingly conscious of the fast reducing effectiveness of antibiotics due to proliferation of bacterial strains, called superbugs that are resistant to multiple drugs or even to all drugs. Consequently, pneumonia and urinary tract infections are becoming far more difficult to treat as antibiotics most commonly used to treat urinary tract infections are now considered ineffective for more than half the patients in many parts of the world and forms of tuberculosis resistant to commonly used antibiotics are growing by the day. The financial toll of countering the resistance to antibiotics is considerable. The World Bank estimates that projects to counter drug-resistance of superbugs could cost $1 trillion to $3 trillion in lost output annually by 2030 and their main brunt will be borne by the developing world.
To make matters worse is the lack of new medications arriving on the horizon. Though scientists have developed variations in antibiotics but they are not sufficient to tackle the growing menace of drug-resistance. Pharmaceutical companies find it increasingly difficult to overcome the resistance offered by bacteria and to develop drugs that can confront the most potent gram-negative bacteria. The hard task lying ahead could well be gauged by the fact that of nearly fifty antibiotics currently in the pipeline only a dozen appear to tackle the fast mushrooming bacterial formations.
The western world has pumped in tens of millions of dollars and launched one of the greatest joint ventures to fight superbugs. The European Commission has backed an initiative to streamline research happening across the continent, while Group of Twenty (G20) nations are also working to find ways to counter drug-resistant bacteria. Another EU-sponsored public-private partnership has allocated 700 million Euros for this purpose. In order to reverse the growing tide of resistant bacteria and to restore antibiotics to their well deserved place as primary medicinal treatment an intense global response is the need of the day. To begin with, unscrupulous use of antibiotics needs to be curbed. There is an abject need for arriving at an international accord to meet the challenge. Antibiotics are the priceless treatment human beings have developed for their safety. Showing cognizance to the urgency of the voices are growing underscoring the need to launch a concerted and broad campaign to counter the growing resistance of fatal bacteria. TW