The coming of superbugs

By Henrylito D. Tacio
“Unless we take significant actions to improve efforts to prevent infections and also change how we produce, prescribe and use antibiotics, the world will lose more and more of these global public health goods and the implications will be devastating.” — Dr. Keiji Fukuda, the World Health Organization’s assistant director-general for health security.
 
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Dr. Emmanuel Edwin R. Dy, then senior research specialist at the Philippine-Australia Cooperation Project on National Drug Policy, reported that Filipinos use antibiotics inappropriately.  He based his statement from the results of his 1995 study, which he presented in a symposium convened by the Philippine Council for Health Research and Development.
“This research was brought about by the desire of the government to address the problem of antimicrobial resistance in the country,” Dr. Dy pointed out during the symposium.  “The government wanted somebody to come up with raw data, with hard evidence that there is resistance brought about by inappropriate use of antibiotics.”
Inappropriate antibiotic use refers to improper administration with respect to choice, dose, interval, and duration in the light of proper clinical situations and/or financial considerations.
In his study, Dr. Dy found out that most Filipinos use antibiotics inappropriately because of misconception, financial constraints, prescription recycling, and widespread self-medication.
Dr. Dy acknowledged that the problem of inappropriate, which leads to improper, use of antibiotics in the Philippines is rather complicated.  “There is no simple solution,” he deplored.
The Philippines, however, is not alone in this dilemma.  “Globally, we have recorded 50 percent antibiotics overuse and the number is still increasing,” said the World Health Organization, the United Nations health agency based in Geneva, Switzerland.
“In many countries, antibiotics are available without doctor’s prescription, which lets patients diagnose and dose themselves, often inappropriately,” Time journalist Michael D. Lemonick wrote. “And high-tech farmers have learned that mixing low doses of antibiotics into cattle feed makes the animals grow larger.  Bacteria in the cattle become resistant to the drugs, and when people drink milk or eat meat, this immunity may be transferred to human bacteria.”
But even when doctors dispense antibiotics properly, there is no guarantee they’ll be used that way.  Several studies have shown that a third of all patients fail to use the drugs as prescribed.  In his special Time report, Lemonick wrote: “Patients frequently stop taking antibiotics when their symptoms go away but before an infection is entirely cleared up.  That suppresses susceptible microbes but allows partially resistant ones to flourish.”
 
Emergence of superbugs
The inappropriate use of antibiotics is the primary cause of the emergence of what health experts called as superbugs.  These are antibiotic-resistant bacteria that pose a deadly threat to humanity; in fact, they are now evolving to become a global threat.
One of the best known superbugs, Methicillin-resistant Staphylococcus aureus (MRSA), is alone estimated to kill around 19,000 people every year in the United States — far more than HIV and AIDS — and a similar number in Europe.
“If we keep using antibiotics improperly, the day may come when our antibiotics no longer work against bacterial infections-we will have an infectious disease apocalypse that will endanger the human race,” said Dr. Rontgene M. Solante, an internist and infectious diseases specialist.
“The overuse of antibiotics — especially taking antibiotics even when they’re not the appropriate treatment — promotes antibiotic resistance,” the US-based Mayo Clinic explains.  “Antibiotics treat bacterial infections but not viral infections.”
For example, an antibiotic is an appropriate treatment for strep throat, which is caused by the bacterium Streptococcus pyogenes.  It’s not, however, the right treatment for most sore throats, which are caused by viruses.
“If you take an antibiotic when you actually have a viral infection, the antibiotic is still attacking bacteria in your body — bacteria that are either beneficial or at least not causing disease. This misdirected treatment can then promote antibiotic-resistant properties in harmless bacteria that can be shared with other bacteria,” the Mayo Clinic further explains.
According to Dr. Solante, there are already two types of bacteria that are already antibiotic-resistant in the Philippines:  one that causes gonorrhea and another that causes tuberculosis (TB).
Drug-resistance cannot only impede the treatment of many common infections, it can also contribute to more serious illness and increased deaths, as well as raising costs of treatments.
Treating a single case of multidrug-resistant TB, for instance, can cost as much as US$250,000.  In comparison, treating a person with non-resistant TB can cost as little as US$13.  “Antibiotic resistance is a particularly difficult problem in developing countries, where the ability to obtain costlier and more effective antibiotics is compromised by lack of financial resources,” notes a report released by the Washington, D.C.-based World Resources Institute.
 
The origin
Although the mechanisms of antibiotic action were not scientifically understood until the late 20th century, the principle of suing organic compounds to fight infections has been known since ancient times.
Crude plant extracts were used medicinally for centuries, and there is anecdotal evidence for the use of cheese molds for topical treatment of infection.  The first observation of what would now be called an antibiotic effect was made in the 19th century by French chemist Louis Pasteur, who discovered that certain saprophytic bacteria can kill anthrax bacilli.
In the first decade of the 20th century, German physician and chemist Paul Ehrlich started experimenting with the synthesis of organic compounds that would selectively attack an infecting organism without harming the host organism.  His experiments led to the development, in 1909, of salvarsan, a synthetic compound containing arsenic, which exhibited selective action against spirochetes, the bacteria that cause syphilis.  Salvaran remained the only effective treatment for syphilis until the purification of penicillin in the 1940s.
Penicillin was discovered accidentally in 1928 by British bacteriologist Alexander Fleming, who showed tis effectiveness in laboratory cultures against many disease-producing bacteria.  This discovery marked the beginning of the development of antibacterial compounds produced by living organisms.
The first antibiotic (which comes from two Greek words: anti, “against,” and bios, “life”) to be used successfully in the treatment of human disease was tyrothricin, isolated from certain soil bacteria by American bacteriologist Rene Dubos in 1939.
Today, many different classes of antibiotics have been developed.  Each has a different chemical composition and is effective against a particular range of bacteria.  None is effective, however, against viral infections.  Some have a broad spectrum of activity against a wide variety of bacteria.  Others are used in the treatment of infection by only a few specific organisms.
Antibiotics work in one of these ways.  Some, such as penicillin and cephalosporins, are “bactericidal,” which means they actually kill disease bacteria.  These drugs work by damaging the cell walls and causing the bacteria to burst.
Other drugs, like the tetracyclines, are “bacteriostatic,” which mean they hold bacteria in check without killing them.  They work by interrupting the normal processes that allow the cells to grow.  Then, when bacteria can no longer multiply, the body is able to muster its defenses and destroy the germs.
Since their discovery, antibiotics have been hailed as miracle drugs.  “While they have indeed wrought miracles, they cannot cure all infections and sometimes can cause serious harm,” warns Lawrence Galton, a New York-based health writer.  “Often, when antibiotics don’t measure up to expectations, it’s because they haven’t been sued correctly.”
 
Getting the full benefit
Here, Galton shares some guidelines “that can help you get the full benefit” from antibiotics:
Don’t take antibiotics indiscriminately.  There are more than 500 infectious diseases, each caused by a different organism.  Of these, at least 200 cannot be treated with antibiotics.  One reason is that the drug works only against bacteria, and many infections, including the common cold, are caused by viruses.  Although some doctors, often under pressure from patient, will prescribe antibiotics for nonbacterial illnesses, the drugs won’t work in these instances and may cause other problems.
“When antibiotic therapy is given for such ailments, the patient is needlessly subjected to expense and risk of a drug reaction,” maintains Dr. Steven Sahn, associate professor of medicine at the University of Colorado Medical Center in Denver. 
There is also the danger of developing a secondary infection from bacteria that are resistant to the drug.  Antibiotics kill off many harmless bacteria that are normally present in the body.  When resistant bacteria no longer face competition, they may cause trouble.
Take antibiotics for the full period recommended.  Many people stop taking medicine as soon as they feel better, instead of following the doctor’s prescription.  “With too little of the drug, the bacteria may not be completely eradicated and the infection may reappear,” writes Galton.
In addition, surviving bacteria are those with a low-level resistance to antibiotics.  Oftentimes, these bacteria undergo a change that increases their resistance, rendering the drug ineffective.
Learn how to take the drug properly.  Some antibiotics aren’t effective when taken with other drugs or with certain foods.  For instance, tetracycline is particularly absorbed by calcium, so that medicine should not be taken with dairy products.  Similarly, penicillin is partially destroyed by acid and should not be taken on an empty stomach, when acid is at a minimum.  “Failure to take drug properly means, then, that you can actually get less of it than you swallow,” Galton reminds.
Don’t use leftover antibiotics.  Using up old prescriptions for new infections or allowing other family members to use leftover drugs could be dangerous as different drugs have different effects.  The medicine that knocks out one bacterium may be powerless against another.
For example, penicillin works against pneumonia only when certain organisms have caused it.  Using the wrong antibiotic could allow an illness to become more serious or even life-threatening.  In addition, the drug that cured you could be harmful to someone else.
Discuss side effects with your doctor.  Some side effects are only minor annoyances that disappear when your body becomes accustomed to the drug.  However, other reactions can be life-threatening.  While any troublesome symptom should be reported to your doctor, some require notifying him immediately or discontinuing the drug if he can’t be reached.
“Before you take an antibiotic, ask if there are nay dangerous side effects,” Galton cautions. “You should also try to prevent side effects by mentioning any medical condition you have that could make a drug unsafe for you.  The doctor who treats your infection should also know about other drugs you’re taking.  And he should know if you’ve ever had an allergic reaction to any drug.  The one he’s prescribing could have similar effects.”