'Overuse of antibiotics increases the risk of bacterial resistance' | The Daily Star
12:00 AM, April 07, 2019 / LAST MODIFIED: 12:06 PM, April 07, 2019

World Health Day

'Overuse of antibiotics increases the risk of bacterial resistance'

Samir K Saha, PhD, Professor & Head, Department of Microbiology, Bangladesh Institute of Child Health, Dhaka Shishu (Children) Hospital, and Executive Director, Child Health Research Foundation, talks to Maisha Zaman about the growing threat of antibiotic resistance in the context of Bangladesh, its health implications, and how it can be tackled.

The use of antibiotics is on the rise and we are getting increasingly antibiotic-resistant. What are the major causes behind this?

The major cause behind antibiotic resistance revolves around the smartness of the bacteria. It is widely believed that antibiotics inhibit the growth of susceptible bacteria. But bacteria can acquire resistance through mutation and thus defend themselves, if antibiotics are taken abundantly. For survival, bacteria are constantly finding resistance mechanisms to avoid the effects of antibiotics. Therefore, they change their cell walls or synthesise proteins in such a way that antibiotics cannot recognise or bind to them anymore. In fact, there are antibiotics which have become outdated as the bacteria learned the strategies to defend and adapt themselves against those. Additionally, exposure to antibiotics makes the surviving bacteria more likely to be resistant. The less they get exposed to antibiotics, the more they become antibiotic-susceptible. The bacteria also want to get rid of extra burdens, such as by changing their genes to dodge the antibiotic(s), to protect themselves.

How is this affecting our general health, particularly that of the youngsters and children?

The elderly and young people, namely newborns and children, are usually affected by bacterial infectious diseases. We should protect these populations from bacterial infectious diseases in order to ensure their wellbeing. Thus, we need to make rational use of antibiotics in treating these infections. It is important to note that overuse of antibiotics increases the risk of bacterial resistance. It is a common practice in our country to treat any kind of illness as “bacterial disease” though many of these illnesses are neither infectious nor bacterial infection. Furthermore, bacteria are not our enemy. Almost 99 percent of bacteria are beneficial and even essential for our existence. We wouldn't survive in this world without bacteria in our body, particularly in our skin, mouth and gut, and the environment. But the question is about how we manage them. If we create adverse situations by taking antibiotics, they will devise defensive strategies to protect themselves and gradually multiply. Though it is essential to take antibiotics to treat infections caused by bacteria, unnecessary and inappropriate usage of antibiotics may lead to antimicrobial resistance.

How can we raise awareness to prevent the unauthorised buying and selling of antibiotics?

Rational use will reduce the pressure of antibiotics on pathogenic and non-pathogenic bacteria and thereby decrease the burden of antibiotic resistance. The government has taken a great initiative to set up a “model pharmacy”, which has binding instructions to ensure the proper use of medicine. These model pharmacies can be instructed to sell antibiotics only on the basis of authorised prescriptions. If these directives are properly followed, the use of antibiotics will be reduced significantly.

Third-generation antibiotics are now widely used because bacteria have developed resistance to first-generation antibiotics. Pakistan is now faced with a severe challenge in responding to an outbreak of extensively drug-resistant typhoid (XDR), Salmonella typhi, which poses a public health concern as the infectious bacteria of this disease are resistant to both first-generation (amoxicillin, chloramphenicol and co-trimoxazole) and third-generation antibiotics. Azithromycin is the only oral antibiotic that happens to work against this bacterial disease. In fact, this situation presents a more alarming picture before us. The XDR bacteria have already travelled to the US and Syria through travellers from Pakistan. It would not be a surprise if the bacteria also end up travelling to Bangladesh the same way.

How can we ensure a healthier lifestyle?

As I said before, rational use of antibiotics and not selling them without authorised prescriptions are some feasible solutions to control the unnecessary and inappropriate intake of antibiotics. Medical practitioners should prescribe antibiotics rationally and also advise patients not to take antibiotics unless they have been prescribed.

Apart from children, older people are most likely to suffer from bacterial diseases. With the increase in life expectancy, they tend to have more infectious diseases such as pneumonia, and many of them are viral. In many cases, they take antibiotics without any prescription from qualified physicians. Consequentially, this leads to antibiotic resistance.

Infectious bacteria are becoming prevalent in hospitals as well—most of which are multidrug-resistant. The practice of hand-washing before and after interactions with patients is crucial to curb the spread of bacterial diseases, especially in hospital settings.

The emergence of drug resistance is closely associated with our behaviours and practices. There is now widespread use of antibiotics, even in poultry, fisheries and livestock. Ironically, we know little about the use of antibiotics in such fields. These antibiotics show up at our doorstep and eventually get discharged into the environment. All this leads to the emergence of bacteria with resistance to all available antibiotics. If we don't take precautions now, this will put us at risk of a high number of deaths due to bacterial infections, as was the case in the pre-antibiotic era.

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