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Over the years, in India, increased antibiotic resistance especially in the case of tuberculosis has called attention of medical researchers to conduct a depth study in the effects of this microbial resistance.
Three medical researchers working as an Associate Professors at R D Gardi Medical College, Ujjain, Dr. Ashish Pathak, Vishal Diwan and Dr. Megha Sharma, conducted a study in Ujjain to get to know the real cause of the problem and to find out solutions for the same. A part of their study also looked after the impact of antibiotics on environment around, specially focusing on animal husbandry and fisheries.
The team was in Bangalore to present a seminar on ‘Antibiotic Resistance: No Action Today, No Cure Tomorrow’ last week. The seminar was organised by Environment Support Group.
Dr. Ashish, specialised in pediatrics, highlighted a macro perspective of how people in not only India but other nations like France, USA, Mexico, European and Asian countries are becoming addicted to antibiotics.
Antibiotics are medicines formulated to kill microbial bacterias that can threaten one’s life. It either destroys bacteria or reduces its growth. The most notorious illnesses caused by bacteria are tuberculosis, diarrhoea and meningitis.
Antibiotics wrongly prescribed?
Ashish remarked that there are doctors who recommend antibiotic even when it is not necessary. He noted that going to doctor for common cough and cold is not advisable. Patients take antibiotics wrongly for headache, cold and cough. What is more shocking is, even food supplements have antibiotics.
Constant use of antibiotics helps the bacteria to develop immunity against it. Once the body builds resistance towards such medicines, doctors have to make use of stronger and costly medicines.
Ashish explained a vicious circle that a patient undergoes when he/she fails to complete the full course of medicines prescribed by doctors. This leads to infection again, and in turn stronger bacteria that requires high dose.
Example of such a bacterial resistance is noticed in newborn babies, known as neonatal sepsis. Statistics by WHO say 70% of the babies affected by neonatal sepsis cannot be treated by antibiotics.
Studies conducted by WHO in 2011 on antimicrobial resistance, highlighted infections caused due to resistant microorganisms many a times result in failure to respond to standard treatment. This leads to prolonged illness and death.
The death rate caused by such resistant bacteria is two times more than the death caused by a non-resistant bacteria.
In 2004, WHO had prescribed use of a solution with zinc as the best remedy. But out of 850 prescription letters collected during the team’s research work at Ujjain, only 22% of the doctors prescribed the right medicine, while 71% of the letters had prescribed antibiotics. 22% of the prescriptions were completely irrational, the study reported.
Need of technology
Suggesting solutions ordered by WHO, The Evolving Threat of Antimicrobial Resistance Options for Action, edition January 2012, he said that primarily one should learn to fight back the viral infection without any use of antibiotics. One should not continuously indulge in the use of antibiotics. Secondly new technologies should be built in order to tackle the existing bacterial resistance. The prescriptions should be made rationally.
“At present scenario,“ he said, “many antibiotic companies are shutting down due to increased resistance of bacteria.We will not get any new antibiotic with no resistance for the next 20 years, due to lack of technology.”
Medicinal chemicals and environment
Vishal Diwan, professor of Public Health and Environment, said environmental factors such as climate variation, migration, and natural calamities also can cause increased antibiotics resistance.
“Over the years, there has been increase in the pharmaceutical use in our daily lives. Pharmaceuticals are present in the diagnostic agents, dietary supplements, fragrances, deodorants, perfumes, soaps, air conditioners etc. Antibiotics has also found its place in the lives of the animals, fishes and plants, which is used supposedly to enhance their productivity.
He said that one of the reasons of extinction of animals is the rise in the release of pharmaceuticals to the environment directly or indirectly. Here, directly means direct intake of medicines to fight a disease or infection, while indirectly means release of untreated chemicals through waste water, into water bodies.
Aquatic animals, specially big fishes, are highly affected animals, primarily because of two reasons – one is the use of pharmaceutical food products, second is the release of chemicals through waste waster like sewage, rainwater etc. that enter rivers and lakes.
“60% to 70% of the medicines that we consume are released back to environment, without any proper treatment, through faeces and urine,” said Vishal.
There is no mechanism invented for disposal of antibiotics. Residuals of antibiotics are found in milk, vegetables, honey etc. in India. All types of water sources including the glaciers are found to have the residuals, he said, backing his statement with studies made in foreign countries.
“We need to pressurise the government to come out with better policy. Water treatment plants required to be made efficient enough to treat the chemicals,” he added.
Ashish and Vishal both were of the opinion that, at an individual level, one can restrict the use of antibiotics, unless it is not very necessary.
Advocating the measures suggested by studies conducted by WHO 2011 on the antimicrobial resistance, Vishal recommended following measures:
Clinical oriental approaches: Minimise the prescription of antibiotics for viral infections.
Behavioral and social approach: Hands should be washed before eating food, doctors must adopt the habit of washing hands after dealing with patients etc.
Environment approach: Waste water from industries, hospitals and domestic households should be treated well before letting it into the water bodies.
Policy makers: Awareness should be created on the use of antibiotics and policies should be regularised.
Both Ashish and Diwan were of the opinion that the area of antibiotics requires a lot of research in our country. There are very few evidences in India to prove the status of release of antibiotic to the environment, while there are no evidences at all on the agriculture and animal husbandry arena.
Diwan said he and his fellow friends are in the process of studying the efficient use of wetlands. Wetlands are considered to be reservoirs of bacteria like Ecoli, the most harmful bacteria. “We need good and efficient treatment plants. They should be exposed to direct sunlight, which can kill 99% of bacteria.”
A seminar by Dr. Megha Sharma, professor of pharmacology, threw light on increased infections caused to patients in the hospital, that have resulted in high dosage of medicines and prolonged stay in the hospital.
In order to curb down such hospital acquired infections it is must that the doctors, nurses, visitors of hospital acquire the habit of washing hand to abort spread of infection from one person to another.
Towards the end of the session, she gave small demonstration on how to wash hands as recommended by WHO and the seminar was concluded.