Sunday, 10 April 2016
BACTERIAL ANTIMICROBIAL RESISTANCE (BAR)
Bacterial Antimicrobial Resistance (BAR) or Antibiotic Resistance (AR) is the phenomenon of inefficiency of a drug against bacteria in similar therapeutic doses, for which it was effective some time back. In short, the drug fails to kill bacteria against which it was lethal or at least inhibitory previously.
Before taking the discussion of BAR or AR further, we have to realise that bacteria are the oldest living organisms and date back to 3.5 billion years. We must also realise that bacteria are the template and provided the genetic material for the evolution of unicellular animals and plants and later multicellular animals and plants.
The bacteria have and still survive in all kinds of environment possible in the last 3.5 billion years on planet Earth. Their call and genetic material is labile and can transform according to the environment it is exposed to.
Also we must appreciate that human body is the best environment for a bacteria to live in. That is why there are more bacteria in human body than there are cells. But most bacteria are harmless, some symbiotic and some pathogenic, which are kept in check by the immune system of the body.
When the body need help to fight harmful bacteria, antibiotics are prescribed by a Doctor to overcome them. Mostly they are successful but sometimes the bacteria modifies itself and prevents the antibiotic from killing it. This bacteria is now said to be resistant to this antibiotic and this phenomenon is called Bacterial Antimicrobial Resistance (BAR) or Antibiotic Resistance (AR).
The bacteria can acquire resistance in several ways like spontaneous mutations, gene transfer from another bacteria or virus, slow genetic change because of environmental pressure etc. Whatever way bacteria acquires this change, it is able to prevent the concerned antibiotic to kill it, at least majority of bacteria in the colony are not killed.
Thus, bacteria are designed by evolution to survive and to change and survive. We cannot totally eliminate them from the body and nor is it desirable.
Also we can never completely stop bacteria from developing antibiotic resistance because it is bacterial nature. All we can do is to ensure that the balance of power remains in our favour and we are able to destroy harmful bacteria causing diseases in our body most of the time.
But even such favourable balance of power has become difficult in today’s world.
I will examine the most important factors for this adverse shift in balance of power and ways to bring it back in our favour.
>>> As I have given earlier, human body is the best medium for bacteria to survive and grow, including that for pathogenic bacteria. Thus, more the human population grows, more bacteria come in this world. More bacteria means a greater mathematical possibility of acquiring resistance and than passing it to other bacteria.
Places like India, China, Africa, South-East Asia, and South America, where human turnover is very fast are the ideal breeding grounds for Antibiotic Resistance (AR). And these areas are the hotbed of Antibiotic Resistance as borne out by various WHO reports.
Added to the population pressure in the above areas is the high population density, insanitary hygienic conditions, poor waste disposal and you have ideal conditions for the development of Antibiotic Resistance and its spread too.
>>> The other significant factor in the development of antibiotic resistance is the amount of exposure the population gets to antibiotics and the circulating bloodstream antibiotic amount in a given period of time, in a given population. High levels of both lead to constant exposure of bacteria to these antibiotics and as per their nature, they modify themselves to develop resistance against these antibiotics.
>>> Another important factor is the prevalence of bacterial infectious diseases, particularly chronic bacterial diseases like Tuberculosis, Leprosy, Chronic and repeated Upper Respiratory Tract Infections (URTI), Chronic Lower Respiratory Tract Infections (LRTI), Chronic and repeated Gastroenteritis etc. All these diseases require antibiotic treatment of more than one week, with some like Tuberculosis and Leprosy requiring many months of antibiotic treatment.
This prolonged exposure to antibiotics result in changes in bacteria, leading to resistance.
^^^Now, if we examine all above factors, a infectious disease prevalence (both acute and chronic bacterial infections) of 10% or more will be accompanied by very high drug resistance. Such is the case in India and Africa.
^^^A infectious bacterial disease prevalence (Total number of bacterial cases divided by the total population and multiplied by 100) of between 5% and less than 10% will be accompanied by high drug resistance. Such is the case in South East Asia, China and South America.
^^^A infectious bacterial disease prevalence (IBDP) of less than 5% but more than 1% will be accompanied by moderate drug resistance. Such is the case in North America and Western Europe.
^^^A infectious bacterial disease prevalence (IBDP) of less than 1% will be accompanied by low drug resistance. Such is the case in Eastern Europe, Northern Europe (Scandinavia), Russia and Israel.
Now, having understood the basic causes of antibiotic resistance, I will focus on ways to decrease antibiotic resistance and tilt the balance of power in our favour.
<<< Decreasing population growth by proper family planning methods like Sterilisation operations etc. This is most important in India, Bangladesh, South East Asia, Africa and South America.
<<< Judicious use of antibiotics which should be available only on the prescription of a MSMS (Mesopotamian System of Medicine and Surgery) (Allopathy) Doctor.
<<< Antibiotic sensitivity test should be made available and compulsory in all hospitals and clinics where an antibiotic is prescribed. In far flung areas, use of mobile vans can be done.
<<< Safe disposal of expired or damaged antibiotics in incinerators, so that they do not enter the environment like water or soil.
<<< Judicious use of antibiotics in animals. Growth stimulants instead of antibiotics should be used for their growth.
<<< Constant R & D (Research and Development) to develop newer antibiotics. 50% tax concession should be given for newer antibiotics during their patent period.
<<< Strong patent and copyright laws especially in India and China to prevent new antibiotics reaching the market from being copied.
We probably cannot outlive bacteria but with above measures we can control them.
Copyright Tanvir Nebuchadnezar