‘Antimicrobial resistance is a threat to global security and economic stability. It is a looming health and economic crisis that requires both global and local solutions. “Since drug-resistant genes can travel, countries with higher levels of economic and social organization have a stake in the success of measures taken by less-developed countries. In the fight against antimicrobial resistance, we are only as strong as the weakest link.”—Dr. Poonam Khetrapal Singh, World Health Organization (WHO) regional director for Southeast Asia.
Six summers ago, 5-year-old Kathy started coughing hard every night. Her mother, Sarah, took her to a clinic and asked for an antibiotic. The doctor prescribed azithromycin, and Kathy seemed to improve, but a month later she had another coughing attack. The doctor put her on a different antibiotic, clarithromycin.
More illnesses followed—ear infections, coughs, colds, runny nose. In one year, Kathy was given 10 different courses of antibiotics. Then, when she was 9, she was struck down by a terrifying new illness. Her temperature soared to nearly 40 degrees, and she was having trouble breathing. When Sarah coughed, her phlegm was mixed with blood.
Sarah rushed her daughter to a hospital, where doctors diagnosed bacterial pneumonia and prescribed more antibiotics: azithromycin plus amoxicillin/clavulanic acid. When Kathy showed no sign of improvement, tests revealed that she had been hit with a strain of Streptococcus pneumoniae resistant to azithromycin and other common antibiotics. Doctors had only one option left—vancomycin, a potent antibiotic given intravenously. Fortunately, the drug worked and Kathy recovered quickly. “Based on her medical history, Kathy was a prime candidate for a resistant bacterium,” the doctor who took care of her told this author.
Dr. Bernard Fields, a Harvard microbiologist who went through American medical schools in the 1960s, recalled being told by his mentors: “Don’t bother going into infectious diseases.”
“The perception was that we had conquered almost every infectious disease,” notes Dr. Thomas Beam of the Buffalo, New York, VA Medical Center. The polio virus had been tamed by the Salk and Sabin vaccines. The smallpox virus was virtually gone. The parasite that caused malaria was in retreat. Once deadly illnesses, including diphtheria, pertussis (whooping cough) and tetanus, seemed like quaint reminders of a bygone era.
Science was sure the real challenges would be in the conquest of cancer, heart disease and other chronic ailments. Instead, “medicine’s purported triumph over infectious diseases has become an illusion,” Dr. Sherwin Nuland wrote in his best-selling How We Die.
But it seems medicine declared victory and went home too soon. Every disease-causing bacterium now has versions that resist at least one of medicine’s 100-plus antibiotics. In fact, there is now such a thing as antimicrobrial resistance (AMR), a phenomenon where infectious microorganisms previously susceptible to a certain drug become eventually resistant to such treatment.
In the Philippines the 2015 Antimicrobial Resistance Surveillance Program report of the Department of Health said, “Organisms commonly involved in deadly human infections are responding less and less to antibiotics. The alarming fact is that these bacteria are not just becoming resilient to first-line antimicrobials, such as fluoroquinolones and third-generation cephalosporins, but also to strong, last-resort antibiotics called carbapenems.”
An estimated 700,000 cases of AMR from various parts of the world have been reported, according to the 2014 review, Antimicrobial Resistance: Tackling a Crisis for the Health and Wealth of Nations. By 2050 the number is expected to balloon to 10 million. In the United States at least 2 million people are reported to be infected with bacteria resistant to antibiotics and snatching 23,000 lives each year as a direct result of these infections.
The Philippines is not spared from such assault. In an article that came out in Philippine Daily Inquirer, Anne A. Jambora wrote: “Bacteria, viruses and some parasites can now stop antimicrobial medications, such as antibiotics and antivirals, from working against them. Standard treatment then become ineffective, and, soon, in an event of a post-antibiotic era, even the simplest injury or a minor wound could become life-threatening.”
Just recently, the Geneva-based WHO published a list of antibiotic resistant “priority pathogens”, a catalogue of 12 families of bacteria that pose a threat to human health.
“The list is a new tool to ensure research and development respond to urgent public-health needs,” explained Dr. Marie-Paule Kieny, WHOs assistant director general for health systems and innovation. “Antibiotic resistance is growing, and we are fast running out of treatment options.”
In a statement, Kieny said the list highlights, in particular, the threat of “gram-negative” bacteria that were resistant to multiple antibiotics. These bacteria have built-in abilities to find new ways to resist treatment and could pass along genetic material that allowed other bacteria to become drug-resistant, as well.
Reasons for emergence
There are several reasons for this sudden surge of new bacteria and viruses that resist antibiotics. Abuse of antibiotics has been cited as one of the main culprits. “Essentially,” Dr. Lee Green, a family practitioner at the University of Michigan, was quoted as saying by the Newsweek, “we have a tradition of prescribing antibiotics to anybody who looks sick.”
“In many countries, antibiotics are available without doctor’s prescription, which lets patients diagnose and dose themselves, often inappropriately,” Time journalist Michael D. Lemonick added.
“The overuse of antibiotics—especially taking antibiotics even when they’re not the appropriate treatment—promotes antibiotic resistance,” the US-based Mayo Clinic explained. “Antibiotics treat bacterial infections but not viral infections.” But even when doctors dispense antibiotics properly, there is no guarantee they’ll be used that way. This is where another reason comes in: misuse. Several studies have shown that a third of all patients fail to use the drugs as prescribed. In his special report, Lemonick wrote: “Patients frequently stop taking antibiotics when their symptoms go away but before an infection is entirely cleared up. That suppresses susceptible microbes but allows partially resistant ones to flourish.”
This has been fully explained by Sally Davies, the United Kingdom chief medical officer. In her book The Drugs Don’t Work, the author describes how bacteria become resistant to drugs when a person doesn’t take antibiotics for long enough. “If the drugs are not given enough opportunity to fully kill the bacteria, it may survive while also learning how to resist future treatment with the same drug,” Davies wrote. “This is why it is important that antibiotics are only taken exactly as prescribed by a trained medical professional.”
Still another culprit: agriculture. “High-tech farmers have learned that mixing low doses of antibiotics into cattle feed makes the animals grow larger,” Lemonick wrote. “Bacteria in the cattle become resistant to the drugs, and when people drink milk or eat meat, this immunity may be transferred to human bacteria.”
According to Dr. Enrique Tayag, the director IV of the Department of Health Bureau of Local Health Development, when food is mixed with antibiotics, AMR may result. “There is an animal-to-person contamination, and person-to-person transmission,” the former assistant health secretary was quoted as saying. “So now, we’re looking at animal health, food health and human health.”
in a way, environmental degradation has also contributed to the appearance of infectious diseases that resist drugs. “Infectious diseases are a basic barometer of the environmental sustainability of human activity,” Platt pointed out. Francesca Grifo, director of the Center for Biodiversity and Conservation at the American Museum of Natural History, wrote: “One of the clearest examples of how ecosystem disruption affects disease behavior can be seen in the interaction between deforestation and the infectious, and particularly vector-borne, diseases that are common through tropics and subtropics.” (A vector is an organism that transmits a disease from place to place.)
Global political response
To address the looming antibiotic-resistance disaster, a global political response similar to the way the world has reacted to climate change or HIV/AIDS is needed, according to Swedish Minister of Public Health
Gabriel Wikstrom. “Of course, [with antibiotic resistance], we have many technical issues still to solve, and medical issues, as well, but it’s foremost a political issue,” Wikstrom was quoted as saying by the Inter Press Service.
The “business-as-usual” scenario must be stopped at all cost. “What is clear is that all countries around the world need to stop treating antibiotics as if they are sweets,” declared Lord Jim O’Neill, chairman of the Review on Antimicrobial Resistance of the UK. “It’s true in humans, and it’s true in agriculture.” For its part, the health department urges all Filipinos to use antibiotics properly. Tayag suggests that before taking self-prescribed antibiotics, he needs to ask these questions: What is wrong with me? Is this the right medicine? Is it safe? Shall I die because I’m taking this?
“The battle against AMR is continuous and we cannot relent,” Dr. Butch Rector, MSD medical director, told the Philippines Graphic. “It is difficult, but with concerted effort—from patients and doctors, to the government, as well as the private sector—we can be optimistic of a world finally free from AMR.”