The World Health Organisation (WHO) released a report on the 20th of September, 2017 captioned “The world is Running Out of Antibiotics”. You can read the full story here. If you saw only the caption and did not read the report you most likely would have thought WHO is lying. After all, what happen end to all the antibiotics we have in the market. In fact, you still bought last week. Yes, you are right if you say we have so many antibiotics in the market. Even WHO realises there are so many antibiotics in the market. But if that is where you end then you have missed the point of WHO’s report.
Think about it for a little longer. What would make WHO, with all the data and statistics they have, publish such a report? To go a step further, why should we need more antibiotics when we already have so many of them? The answer can be found in the menace called Drug Resistance. Although WHO’s report was limited to just antibiotics, the problem of drug resistance goes beyond that to include antimicrobial as a whole.
What exactly is Drug Resistance and why should you care?
Drug Resistance occurs when a drug that previously worked in the treatment of an infection, illness or disease, stops working for it. To paraphrase that, drug resistance happens when a drug loses its effectiveness in treating a particular ailment or disease. Another name for Drug Resistance is Antimicrobial Resistance. It must be mentioned here that microorganisms are responsible for most illnesses or diseases. These disease-causing microorganisms are referred to as Pathogens.
When we talk of drug resistance, it is actually the pathogens that develop resistance to drugs not humans.
Let me briefly explain what happens when drugs are used to treat microbial infections or diseases caused by microorganisms. Usually when we take drugs to treat an illness or disease caused by microorganisms, the drug works either to kill the pathogens or stop their activity. However due to a number of factors over time, the drug that would have killed or stopped the activity of these pathogens suddenly does not have any effect on them again. It is at this point that we say the pathogens have developed resistance to the drug.
Difference between Antibiotics and Antimicrobial
It is very important to state that antibiotics are not the same thing as antimicrobial. Antibiotics are drugs that work to fight bacterial caused infections or diseases; while antimicrobial cover all the drugs that are used to manage all classes of microorganisms. Antimicrobial include antibiotics, antifungals, antivirals, and antiprotozoans. To state simply, antibiotics are a type of antimicrobial.
Types of Drug Resistance
As mentioned above, there are different types of antimicrobial depending on the causative pathogen or microorganism. As such different types of Drug Resistance or Antimicrobial Resistance also exists. Popular examples include Methicillin Resistant Staphylocccus aureus (MRSA); drug resistant HIV, multi drug resistant Tuberculosis and a very familiar one, drug resistant Malaria. Because of the nature of malaria parasites, it is very easy for them to develop resistance to drugs (that is why there are a huge number of anti-malaria drugs in the market).
Causes of Drug Resistance
A question that will be running through your mind at this time will be what will make a drug that had previously cured an ailment suddenly stop doing so? Reasons for this vary and are broadly divided into two categories: Biological and Societal.
Biological causes have to do with changes in the physiology of the pathogens in question. Typical biological causes of resistance include mutation, change in genomic properties etc. Biological causes of drug resistance are out of our control and I won’t dwell on it in this article.
Societal causes is entirely under our control as humans and it is a major reason why the WHO report is a timely one. Due to our health behaviours especially when we are sick, we play a major role in perpetuating the menace of drug resistance in the following ways:
1. Self medication – Most of us are guilty of using drugs without a proper diagnosis of whatever symptoms we are suffering from. There are times when all we need is proper rest and our bodies will fight whatever pathogens invading our system. However since buying drugs over the counter is very easy we would rather use medication than rest. The danger of self medication lies in using a wrong drug to treat an illness we don’t have. What then happens is that pathogens are exposed to the drug and are able to build resistance against it. By the time we now have the illness the drug is supposed to treat, same drug does not work.
2. Not completing drug dosages – Hardly will a doctor prescribe a drug without a corresponding dosage. We, however, stop using drugs as soon as we stop feeling the symptoms and fail to complete the dosage. The resultant effect of this is that the drugs will work on the pathogens up to the point when we stop taking it irrespective of whether all the pathogens had been killed or not. In a situation where not all the pathogens have been killed, you give them an opportunity to develop defense mechanisms against future exposure to that drug. When you then fall sick and use the same drug, it becomes ineffective as the pathogens have developed resistance to it.
3. Storing medications against future use – Most of us store medications at home long after we’ve been cured of whatever ailment we bought it for. It is to these drugs we turn when we experience the faintest symptoms of any sickness. This habit contributes to the problem of drug resistance.
4. Using the wrong medications– Doctors are guilty of prescribing the wrong medication at times. For example prescribing an antibiotic for a viral ailment or an anti-fungal for bacteria caused ailment.
Effects of Drug Resistance
What exactly does drug resistance have to do with you and why should you care about your drug use? Listed below are the short and long term effects of Drug Resistance to us as individuals:
1. Prolonged stay at the hospital or prolonged period of illness – the major effect of drug resistance is felt when we are sick and the prescribed drugs does not work. The next thing is for the doctor to recommend an alternative drug to treat the condition. What this really means is that if the sick patient is on admission, their stay at the hospital is automatically prolonged. Even if not on admission, it will still take a longer time for the patient to be cured of their illness.
2. Trial and error on many drugs – another effect of drug resistance is the trial and error that takes place when a prescribed drug does not work.
3. Higher cost of treatment – sure you must have figured that having to try different medications to know which would work means that more money will be spent in treating the illness. More so when the patient is on admission and has to pay hospital admission charges. There is also a high cost involved in developing new antimicrobials that will evade resistance mechanisms of pathogens.
4. Death – a very unfortunate but at times inevitable effect of drug resistance is death. Not every condition can allow for time to be testing which drug will work, or which would not. In a situation where time is of essence and using the right drug in time matters, a complication of drug resistance is one no one wishes for.
Prevention of Drug Resistance
We’ve discussed what drug resistance is, the types, causes, and effects. The next thing will be to know what we can do to protect ourselves from drug resistance or control it if possible. I already mentioned that we cannot do anything about the biological causes of drug resistance. The societal or man-made causes are however fully under our control and following the below listed points will go a long way:
1. Avoid self medication – As hard as this may be it is highly recommended that we do not self medicate. Go to the hospital. Have a proper diagnostic test done. Go to a proper pharmacist not the Chemist down your street. Better yet, get proper rest first before going after medication.
2. Do not pester your doctor for medication – this may sound funny but some patients actually pester their doctors to prescribe drugs for them. Some people are just used to taking medications that they would ignore the doctor’s advice that they rest or they allow the illness take its course. Some virus caused illnesses such as flu or catarrh really do not require medication.
3. Dispose leftover medications – except for cases such as high blood pressure, diabetes, and other ailments that require continuous medication, there is no reason why we should keep left over medications at home. Allowance can also be made for painkillers or other essential drugs that are kept in a First Aid Kit. Eliminating this will help us get rid of the temptation to fall back on them when we are sick.
4. Complete your dosage – If the doctor says use the drug 3 times daily for 7 days, follow the instruction. Do not stop because you are now feeling better.
The world is indeed running out of antibiotics as WHO reported. The numbers of scientists working on developing new antibiotics are fewer than the number of antibiotics needed. While you and I may not have the knowledge to go to the laboratory and create more antimicrobial, let us do all we can to ensure the already existing antimicrobial can perform their jobs as efficiently as they can. The benefits are far reaching to our well-being and balance.
Let’s kick out Drug Resistance.
November 13-19 is World Antibiotic Resistance Awareness Week.
Play Your Part.
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