Survival of the fittest equals survival of the ugliest: The threat of Antibiotic resistance

Dudzai Mureyi

When I was young, in protest against my bedroom’s constant state of chaos, my mother once said, ‘If a baby scorpion were to sneak into this room, it would grow into adulthood, live its best life and proceed to die of natural causes before it’s discovered.’

I maintained there was a certain order in my apparent disorderliness – everything was strategically located for my convenience.

Besides, untidiness is the stuff of genius. The world’s first antibiotic, Penicillin, which revolutionised medicine, was discovered in 1928, precisely because Professor Alexander Fleming was untidy, or a sloth, or both – but it’s likely he was simply untidy. Legend has it that the eminent Professor Fleming had been working on two separate projects. One involving bacteria and another involving the mould from which Penicillin is derived. When he closed his laboratory to head off for a summer holiday, instead of washing up and squirrelling away everything to its proper storage place, he piled his dirty apparatus in some corner, inadvertently bringing the mould and the bacteria samples into contact, and off he went. When he returned from vacation, lo and behold,  bacteria population that had come into contact with the mould had been destroyed.  Medicine hasn’t been the same since. Today though, one of the real threats to global health security is the rendering of antibiotics useless, by the rapid development of antibiotic resistance.  Antibiotic resistance is when bacteria becomes inured to antibiotics that previously eradicated them. This has especially dire consequences if the bacteria were only susceptible to a few antibiotics to begin with and if the diseases they cause is fatal and infectious, for example, T.B.

Resistance is a legitimate concern nowadays because of the high rate it is happening and the waning motivation to invest in developing new antibiotics. A few weeks ago, Norvatis, a big pharmaceutical company announced its plans to withdraw from the antibiotic developing business, citing poor returns on investment. This announcement should disconcert us because the antibiotic-development endeavour needs every dime that can be spared. A world in which antibiotics don’t work is truly apocalyptic – the stuff of sci-fi thriller movies. Simple ailments would become death sentences.

Today, dear readers, we have a quick discussion about what antibiotics are for and how we can do our bit in the good governance of antibiotics to ensure we continue to enjoy their utility.

What are antibiotics used for?
I know of people who don’t feel treated unless they’re prescribed an antibiotics course.

And those that think every effective medicine’ s an antibiotic. So, for the avoidance of doubt, let’s begin by clarifying. An antibiotic’s a medicine that kills or impedes the proliferation of bacteria. Having gotten that out of the way, allow me to dispel a very unfortunate myth that has folks believing that antibiotics cure colds and flus. Colds and flus are caused by viruses, not bacteria. Antibiotics are therefore not effective against a bona fide flu or cold. However, the reason one might be prescribed an antibiotic for a cold or flu is that, bacteria can sometimes take advantage of the weak immune defences in a person suffering from a viral cold or flu and invite themselves to the festivities. Secondary infection by bacteria then complicates a common cold that would have resolved itself with the aid of fluids, vitamins, bed rest and pampering.

In addition to treating bacterial infections in humans and animals, antibiotics are used in certain instances as a preventative intervention. A good example of this is their use before and after surgical operations to prevent the infection of the patient whose internal body is exposed during the procedure. Another example of prophylactic antibiotic use is the daily ingestion of antibiotics to keep infections that tend to take advantage of weakened immune systems away. Our immune systems are usually able to maintain a tight leash on bugs- preventing them from becoming a diagnosable infection. Our immune systems are constantly waging intense battles we know nothing of. However, in special circumstances, for example in instances of cancer treatment, HIV infection or aggressive long-term treatment with steroids, our immune systems need reinforcements in the form of daily antibiotic doses, to keep performing this task.

Last, the booming world population has necessitated the production of food at an industrial scale to sustain food security. Antibiotic use in animal and food crop farming to maximise yield by promoting growth and preventing bacterial infection of the produce is a well-documented practice.

Why should we regulate how antibiotics are used?
Apart from the fact that resistance is sped up by the frequent and indiscriminate exposure of bacteria to antibiotics, not every infection is a bacterial infection, not all bacteria are worth killing. Good types of bacteria keep our bodies functioning normally and guard against rogue germs. Killing them would actually induce ill-health or delay the resolution of an existing illness. Some of the side-effects of aggressive treatment with antibiotics result because the antibiotic taken would have obliterated both the good, the bad and the ugly. For instance, women might discover that a bout of vaginal thrush follows the completion of an antibiotic course. This is because the friendly bacteria that normally resides in healthy vaginas, keeping yeast at bay, would have been temporarily wiped out. Stomach problems can also result after the good bacteria in the gut would have become collateral damage during antibiotic treatment. Protecting the population of good bugs in our bodies is one reason the use of antibiotics in humans is tightly controlled.

Antibiotic Stewardship: The Do’s and Don’ts
Health systems everywhere are and should be seized with the matter of ensuring that we approach the apocalyptic phase of antibiotic resistance as slowly as possible. This is not simply the responsibility of pharmacists, doctors and nurses. Everyone can do their bit- starting by not throwing a tantrum each time a pharmacist refuses to dispense an antibiotic in the absence of a valid doctor’s prescription. A doctor’s prescription assures the pharmacist that a proper assessment has been made, to determine that an antibiotic is the suitable course of treatment.

Everyone can also exhibit good antibiotic stewardship by finishing the entire course of antibiotics given, even if one starts to feel fine before the medication has been finished. The exception to this rule is when one develops an obvious allergic reaction to the medicine. In which case, stopping treatment and promptly informing your doctor or pharmacist is the thing to instead. Such reactions usually manifest as rashes.  This is why completing the full course of antibiotics is crucial: In a bacterial population, there’s a few really stubborn ones that don’t die at the average antibiotics doses. When one stops taking the medication midway, the weak and average bacteria would have died but these stubborn ones would have survived. They then regroup, reproduce, and before long, form a whole new strain of bacteria that doesn’t succumb to the antibiotic initially exposed to.

The benefits of the greatest serendipitous discovery in contemporary Medicine, now requires our careful and deliberate efforts to preserve. We owe it to the messy Professor Fleming, to ourselves and to future generations, to delay catastrophic antibiotic resistance, for as long as possible.

Dudzai Mureyi is a pharmacist skilled in health policy analysis, currently pursuing doctoral studies in Global Health.  Find her on Twitter: @BonnieDudzai or email her at: dudzai8787@gmail.com

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