The bug is actually a single-celled bacteria belonging to the Eschericia coli (E. coli) family. The species carries an enzyme called New Delhi metallo-beta—lactamase (NDM-1), which allows it to neutralise all known antibiotics and survive in their presence.
The enzyme was first isolated from a patient who had come to India for elective surgery. When he left, he took the “super bug” with him. No one knows how prevalent the organism is in India, as we do not have a centralised surveillance and reporting system that tracks hospital acquired infections and bacterial antibiotic resistance patterns.
Resistance is not a new phenomenon. Sulpha drugs and penicillin — the first antibiotics — were once hailed as “miracle” drugs. Today, they are hardly used. Overuse and misuse resulted in almost all bacteria becoming resistant to them.
If appropriate antibiotics are administered during a disease process caused by bacteria, the germs die. The host develops antibodies that help the body eliminate the weakened organisms.
E. coli has been around for thousands of years. That’s because the microorganisms developed “plasmids”, stable genetic elements composed of DNA or RNA. These help the bacteria grow resistance to chemicals and antibiotics. Once they have acquired this ability, they pass on the gene to other bacteria, even belonging to different species. Staphylococcus aureus and Klebsiella too have developed multiple drug resistance.
The outbreak of plague in Gujarat in 1994 killed hundreds. The state government realised the disease could be controlled by preventing rats from infesting human habitation and with appropriate antibiotic treatment. The situation was thus brought under control.
The spread of antibiotic resistance too can be controlled with combined concentrated effort. People are often “too busy” to consult a doctor when they are ill. The neighbourhood pharmacy then seems an attractive alternative. The man at the counter (often not a qualified pharmacist) dispenses antibiotics for coughs, colds, fever and diarrhoea. But there is often no rational or appropriate use of antibiotics.
Also, people sometimes do not complete the full course of a drug. They keep a few tablets, popping them for similar symptoms later or dispensing them to friends and relatives. A single dose may temporarily suppress the symptom. In a previously healthy person, the body’s natural defences then take over and eliminate the bacteria. The elderly or those with poor immunity become sicker, requiring the services of a qualified doctor. The bacteria, meanwhile, thrives in the presence of the antibiotic, because either they were not susceptible or the dosage was too small to be effective. Antibiotic resistance develops.
Practitioners of alternative systems of medicine prescribe and dispense antibiotics (which they are not licensed to use) inappropriately, perpetuating the problem.
At times, qualified physicians and surgeons use antibiotics prophylactically, especially after surgical procedures, to “prevent infection”. These antibiotics are eventually excreted by the body. They reach the sewage systems and seep through the earth. Bacteria are naturally present in sewage. They spread and multiply in the presence of the antibiotic.
Cattle and poultry feed are laced with antibiotics to “prevent” infection. Antibiotic resistant bacteria thrive on farms.
Everyone must play his or her part well to prevent another plague with super bugs which places the entire world population at risk.
• Take treatment only from qualified physicians
• Always buy antibiotics with a prescription, not OTC
• Complete the course in the dosage prescribed
Hygiene has to be maintained not just in the hospitals but also at home. Regularly washing hands, an elementary procedure, reduces infection and its spread.
Governments, nationally and internationally, need to maintain surveillance to monitor emerging infections and drug resistance patterns. If everyone — patients, doctors and the public — does not co-operate on a war footing, we may revert to the dark ages of the pre penicillin era. No antibiotic will work against infections and developing an infectious disease will turn out to be a death sentence.
An Article written by Dr Gita Mathai
Source: The Telegrtaph (Kolkata, India)
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