Antimicrobial resistance: no action today, no cure tomorrow is a very catchy slogan but where is the real problem! Rightly enough, on the occasion of the World Health Day on 7th April 2011, in this year’s theme "Combat Drug Resistance", WHO calls for urgent and concerted action by governments, health professionals, industry and civil society and patients to slow down the spread of drug resistance, limit its impact today and preserve medical advances for future generations? But where is the real problem ?
More than half a century back the discovery and use of antimicrobial drugs to treat diseases such as leprosy, tuberculosis, gonorrhea, syphilis and many other hitherto incurable diseases changed the course of medical and human history. It is a matter of our civilizational concern that those discoveries and the generations of drugs that followed them are now at risk, as high levels of drug resistance threaten their effectiveness. Drug resistance induced through mutations is a natural biological phenomenon, through which microorganisms acquire resistance to the drugs meant to kill them. Gradually and with passing generations coupled with high reproductive rate, the microorganism carrying the resistant gene becomes ever more dominant until the drug is completely ineffective. From a biological perspective the optimal mutation rate for a species is a trade-off between costs of a high mutation rate and the metabolic costs of life maintenance systems to reduce the mutation rate, through the DNA repair enzymes. Incidentally, viruses that use RNA as their genetic material have rapid mutation rates, and as these viruses evolve rapidly they evade the defensive response of the human immune system. The rampant, improper, in discriminatory and ineffectual usage and prescription of drugs has added to the malaise in many developing countries such as India. So what are the policy recommendations by the WHO worldwide?
- develop and implement a comprehensive, financed national plan
- strengthen surveillance and laboratory capacity
- ensure uninterrupted access to essential medicines of assured quality
- regulate and promote rational use of medicines
- enhance infection prevention and control
- foster innovation and research and development for new tools.
The WHO Director-General Dr Margaret Chan has ominously been cited . “In the absence of urgent corrective and protective actions, the world is heading towards a post-antibiotic era, in which many common infections will no longer have a cure and, once again, kill unabated.”
It is reported by the WHO that last year, at least 440 000 new cases of multidrug resistant-tuberculosis and extensively drug-resistant tuberculosis were reported in 69 countries to date. The malaria parasite has been the cause of 225 million cases worldwide causing nearly 800,000 deaths worldwide having acquired resistance to even the latest generation of medicines, and resistant strains are limiting treatment options. Serious infections acquired in hospitals can become fatal because they are so difficult to treat as drug-resistant strains of microorganism such as those causing gonorrhea and shigella are spreading from one geographical location to another in an interconnected and globalized world. Of late instances of resistance is also emerging to the antiretroviral medicines used to treat people living with HIV. Situation in the developing world is serious as doctors and pharmacists directly prescribe and dispense the drugs, they also automatically give either the newest or best-known medicines without any cost or potency considerations. Also many a times patients have been demanding that doctors give them antibiotics and the doctors are quick to oblige even when they may not be appropriate. Thus given the right frame of awareness and enforcement in the developing world health professionals can help rapidly reduce the spread of infection as also drug resistance.
The WHO, as also the national governments have perhaps not given adequate attention to the relation between human and animal health, and the use of pesticides and fertilizers in agriculture for food and animal production that has led to several cases of increased drug resistance. Interestingly it is reported that approximately half of current antibiotic production is used in agriculture, not only to promote growth and prevent disease but also for better quality and many of the drug resistant microbes generated in animals will sooner or later be transferred to humans.
The WHO has to ensure that national governments work closely with industry and also the civil society to bring about better awareness to the issue of overuse and misuse of antibiotics. It is reported that less than five per cent of products in the research and development across the globe in various laboratories are antibiotic drugs. Perhaps the solution to the problem will lie in innovative incentive schemes to encourage industry to research and develop new antimicrobial drugs. But this can be brought about only by greater investment in research and development of new diagnostics and drugs that most nations particularly in the developing world can ill afford.
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