Antibiotic Resistance: We Are Fast Losing The ‘War’
Dr Adam Mustapha, FASLN
Monday, 18 November 2019
This article was published to mark the World Antibiotic Awareness Week and it was inspired by the Wellcome Trust funded African Science Literacy Network. However, the views expressed in it are those of the author alone - and do not necessarily reflect the views of Wellcome Trust.
The world is losing the war to the ‘bugs’ as a result of actions and inactions of man, facilitated by natural selections which made resistance a natural phenomenon. The warnings of Sir Alexander Fleming didn’t reach the world or man has turned deaf ears. The father of chemotherapy warned of the dangers of resistance immediately when he discovered the ‘magic bullet’, and now the world is moving to the post-antibiotic era which will mark the end of the golden era of antibiotics. True to his prediction, microorganisms became resistant to penicillin, less than a decade after it was introduced for clinical use. Imagine an era where simple infections could not be treated with antibiotics. Simple theatre operations such as Caesarean Section (CS) cannot be done due to the fear of infection with a resistant organism. That’s the period the world is heading to unless drastic measures are taken.
Antibiotic resistance is a natural process in which bacteria become less susceptible to the action of an antibiotic that was once effective against them. On personal experience, I have seen such times when my relative succumbed to the bug, Klebsiella, which was totally resistant to over 9 different antibiotics, including Augmentin. For such a person, the post-antibiotic era is real, because the drugs are tamed useless by the superbug!!! The threat posed to the global health sector by the rise of antibiotic resistance can’t be overemphasised. In fact, experts projected that infections related to antibiotic-resistant organisms will contribute to over 10 million deaths worldwide on an annual basis by 2050. This will cause a great economic burden if these ‘faceless monsters’ are not halted.
It was not surprising when the Chief Medical Officer of the UK, Professor Dame Sally Davies once suggested that the antibiotic resistance threat should be treated equally to the threat of terrorism! Put it this way, if we all view the dangers of antibiotic resistance the same way as the dangers of insurgency in northern Nigeria, it will show the gravity of the problem to the public and policymakers in Nigeria. In his foresight, Fleming blamed the action of man’s unnecessary use of antibiotics to the development of resistance. “The thoughtless person playing with penicillin is morally responsible for the death of the man who finally succumbs to infection with the penicillin-resistant organism.”
In the uncontrolled use of antibiotics, we are all culprits, from the experts to the general public. Unnecessary prescription of broad-spectrum drugs by medical personal, prescription without sensitivity testing, the lack of antibiotic stewardships, who to prescribe antibiotics to and selling antibiotics over the counter without a prescription. In Nigeria, like many developing countries, it is easy to see antibiotics sold by vendors on the streets and motors parks, and anyone can go to the medicine store and purchase antibiotics without prescription. It is a common norm in Northern part of Nigerian cities and towns to hear “a ba ni Ja da Yalo”, which loosely means “I want to buy Red and Yellow” referring to tetracycline - an antibiotic used to treat a wide range of infections but wrongly used by such people. There is a serious misuse of antibiotics in our part of the world, and there are little efforts in reducing this by either stakeholders or the public. It is an established fact that the overuse of antibiotics increases the selection pressure of resistance. Unless something is done to control the overuse of antibiotics effectively, it will remain a loophole through which resistance will continue to wax.
Dr Adam Mustapha
Another factor that fuels the emergence of resistance is the use of antibiotics in agriculture and animal husbandry. The quest for massive production of agricultural products especially increases the search for cheap and large scale proteins. Tones of antibiotics are sparkly used for non-medical purposes. In fact, two-third of the world antibiotics that are meant for human consumptions are directed as growth promoters, feed additive and for prophylaxis in animal husbandry and poultry. These animals are not sick but are ‘intentionally’ being exposed to antibiotics that they do not need. Thus they serve as a breeding spot for the development of resistance. Such an act puts people at risk of getting resistance because there is a strong link between transfers of resistance via food chains to humans. The quest for agro-business enterprise and increased world population made it necessary for the high demand for animal proteins. Although there is strict legislation against the use of antibiotics in farming and animal husbandry in some countries, especially developed countries. In countries like Nigeria, it is challenging to have control of what purpose an antibiotic is going to be used for. People operate poultry at the back yard of their houses without being monitored; they use broad-spectrum antibiotics for prophylaxis to increase their yield and profit, regardless of the threat, if at all they know.
Development of resistance is multifaceted that allow the bugs to be recalcitrant in many ways, including “gifting” resistant genes to their fellows. How cool!
Another angle is our environment. Our environment serves as a resistance hub that allows the exchange of genes between microorganisms. Therefore, there is a need for proper cleaning and treatment of the environment, especially wastewaters that are coming from both community and hospital settings, before such waters discharge to larger water bodies. There are scientific facts that showed that quantities of antibiotic traces are found in nearby rivers of many cities across the world. These come either from animal houses or small doses of drugs that are not completely observed during human treatment. Such environments become hotspots for the breeding of resistances. In the event of no effective water treatment process, such water will be channelled back to the community and subsequently might end up for human use.
Socio-economic status of individuals plays a role in many human lives, including the development of antibiotic resistance. Sub-standard antibiotics are produced to be sold at a cheaper cost. Sometimes, it is due to the fact that some people cannot afford to purchase a complete regimen of antibiotic prescriptions due to economic constraints. In such a situation, sub-optimal doses are created, which is known to facilitate the emergence of resistance. As someone with interest in resistance of superbugs for two reasons; 1) As a research area, 2) and someone that lost loved one due to infections related to drug resistance bacteria, I still remain optimistic that the “war” can be maintained at a balance. While bugs continue becoming less sensitive to the available drugs, we can look for alternatives to conventional antibiotics such as herbs and their essential oils.
However, there is a need for the optimisation and validation of such alternatives. It is well known that in the last decade, there are very few introductions of new antibiotics because Pharmaceutical companies are becoming less interested or do not want to invest huge fund into research and development of a new class of antibiotics. Instead, they focus more on the development of drugs for “cosmopolitan” diseases such as neurodegeneratives diseases and cancers. So, it would not be a bad idea to search for an alternative. Another set of alternatives that have bright hopes in the treatment of superbugs are the use of new scientific concepts such as phage therapy, maggot therapy and science of proteomics.
Overall, people need to be enlightened on the consequences of antibiotic resistance, and this can be achieved through collaboration between scientists and journalist as recently demonstrated by the workshop organised by TReND in Africa in partnership with the University of Sussex and Crick Institute London, supported by the Wellcome Trust, which was aimed at increasing public awareness and engagement with scientific research. I will end with these few words; don’t use an antibiotic when not needed; otherwise, you will be the reason the world will be sent to the post-antibiotic era!
Adam Mustapha, PhD., Clinical and Medical Microbiologist, University of Maiduguri, is a Fellow of African Science Literacy Network (ASLN)