The writer is a doctor based in Islamabad. He tweets @drkhalidshab and can be reached at khalid.raja@live.com
The World Health Organisation (WHO) has named antibiotic resistance as one of the three most important public health threats of the 21st century.
We have long been fighting a war with the microscopic world but being beyond our visual spectrum this war has not received much attention. Our adversary, the microbes, inherently possess extraordinary survival skills. They were one of the first beings on earth and have, till today, successfully managed to hold their ground.
After enjoying a triumphant century, the glorious antibiotic era is coming to an end as the once weak microorganisms (bacteria) have now transformed into superbugs which have rendered these golden bullets (antibiotics) useless by developing resistance.
We in Pakistan have contributed greatly to this global health crisis. We have misused, overused, and self-medicated ourselves and others with antibiotics. Our collective ignorance has brought us at the threshold of the post-antibiotic era, where conditions such as a minor skin cut could lead to untreatable, resistant infections and hence imminent death.
What we have failed to comprehend is that antibiotics are not ordinary drugs.
Antibiotics work only against bacteria. This medical principle has failed to incorporate itself among our masses. Patients having viral infections such as common cold or flu force doctors to give them antibiotics for quicker remedial results.
Antibiotics, when prescribed for common bacterial infections such as typhoid fever, are to be taken at a fixed dose for a specific period of time. Sadly, there is a big population of patients in rural areas who unknowingly visit quack clinics where they are administered a single antibiotic dose and are sent home after temporary relief. After a day or two these under- dosed patients report to government doctors with untreated infection and worsening condition.
For these reasons, bacteria have undergone evolution to resist a wide range of antibiotics. At the same time, the global pipeline producing new antibiotics has dried up. Our options have dramatically declined.
Pakistan’s farming industry is another major contributor towards antibiotic resistance. For monetary gains, farmers inject antibiotics into farm animals to prevent infections and to speed up the growth of their livestock. This unregulated practice has transformed farm animals into disease-spreading machines which harbour antibiotic-resistant bacteria till they reach our dining tables.
A 16th century Swiss physician, Paracelsus, summarised this subject in the following words: “All things are poison and nothing is without poison; only the dose makes a thing not a poison.” Rightly so, even if food, water or oxygen is taken in quantities greater than what is required by the body, it can lead to perilous outcomes. Similar is the case with antibiotics. Their immense success has plunged us into an ‘era of misuse’.
So how can we overcome our unhealthy obsession with antibiotics? We need to start with recognising antibiotic resistance as an issue and our health ministry should vocalise the significance of this public health crisis. Secondly, legislating (which for our collective ignorance has never been done in the 71-year history of Pakistan) against over-the-counter availability of antibiotics is required on a war footing. Lastly, we need to counter the socially embedded trait of self-medication in our society by running advertisements on print and electronic media, educating people about the dangers of unnecessary antibiotic usage.
If our current practices remain unchanged, we would soon be thrown out of the magical antibiotic era into an age of poor disease prognosis and mortality. We must act now.
Published in The Express Tribune, February 6th, 2019.
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