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April 7th, World Health Day is meant to raise awareness on vital health issues today. This year’s theme? ‘Combat Drug Resistance’.
What is drug or antibiotic resistance and how has it become such a serious health issue today as to merit a World Health Day devoted to it?
Let’s start with an example. 6 year old Riki came back home from school with high fever and general irritation. On seeking medical advice, her parents found that Riki was suffering from a urinary infection. The doctor asked for Urine tests, both regular and culture test (where urine is cultured to see the presence of bacteria and then their resistance to different antibiotics). But to bring down the fever and the irritation, the doctor prescribed an antibiotic course before getting the results of the tests.
On getting the Urine culture report where bacterial growth in urine is tested against different antibiotics to find proper medication against it, Riki’s parents found that she was already resistant to the prescribed antibiotic and they understood why Riki’s condition was not improving in spite of the medication. The doctor changed the medication; the new one worked. Many of us would have come across this scenario.
Every pathogen (disease-causing organism) does go through a natural process of selection and after a long period of time, becomes resistant to a particular chemical/drug. But the process is speeded up due to some intervening conditions, especially in developing countries like India.
While drug resistance may be a natural phenomenon, there are reasons for its increase in modern times:
More diseases: India is a tropical country where infection carriers like mosquitoes due to their high mutation rate are almost impossible to eradicate. The large and ever-growing human population of this country with poor health habits owing to lack of money, awareness and sanitation facilities results in the rapid spread of infectious diseases like Malaria, Tuberculosis, and HIV-AIDS.
Generic drugs: The development of a new antibiotic, anti-retroviral or anti-protozoal drug requires years of research in modern equipped laboratories and large amounts of money. In order to get patents for a new active ingredient from international bodies like the FDA, drug manufacturers must meet many stringent conditions. In India however, relaxed patent laws have created a Mecca for pharmaceutical giants. Since antibiotics can be reverse-engineered and reproduced as generic drugs, prices remain quite low.
… my own perception after living in three different countries (India, the U.K and Germany) is that the low cost of antibiotics also leads to their over-prescription, not just by medical practitioners but also at pharmacies.
The whole process is beneficial for providing drugs to the poor population of developing countries. However, my own perception after living in three different countries (India, the U.K and Germany) is that the low cost of antibiotics also leads to their over-prescription, not just by medical practitioners but also at pharmacies. And a great responsibility falls on to this level to control the use of these drugs, which brings us to:
Over use of drugs: Prescription of drugs is not properly controlled by the governing bodies, for both paediatric and adult patients in India. For example, in countries like Germany, it is a recent practice that a baby below one year is not given antibiotic unless s/he suffers from severe ear, lungs or kidney infection. Ordinary citizens are made aware of the dangers of over use of prescription drugs through the media. For viral infections, antibiotics are an absolute no-no. Enhancement of natural immunity through proper nutrition, rest and exercise among children and in people of advanced age is given a lot of importance.
In India, we have no such control. Antibiotics are prescribed for high fever caused due to viral infections with the reasoning that the body’s immune system will be affected due to viral infection that can further expose the patient to bacterial infections. So, antibiotics move from being a protective measure to a preventive measure.
Yes, here again all the factors like India being a tropical country and unhygienic living conditions comes into the picture which makes an Indian patient more prone to bacterial invasion as compared to his/her European counterpart; in the process though, these measures also reduces the resilience of an antibiotic.
A visit to an allopathic doctor is an expensive affair for many in India and they approach the pharmacies to get a course of antibiotics for treatment of sore throat and fever; once again, improper use of antibiotics.
Not completing the course: Due to lack of awareness and for economic reasons, many times the full course of the medicine is not taken. It is a critically essential condition as one dose of antibiotic is not enough to kill all the invading bacteria. Not taking the full course of antibiotics means that you are leaving some leftover pathogenic bacteria to survive in your body which can reproduce and spread in the environment or cause relapse of the disease in your body. These resistant bacteria are called superbugs in common terms. The chances are that the next time, if treated with the same antibiotic, your body might not react to this. In case of tuberculosis patients, this is a common problem.
Not taking the full course of antibiotics means that you are leaving some leftover pathogenic bacteria to survive in your body which can reproduce and spread in the environment or cause relapse of the disease in your body.
Antibiotics in farming: Antibiotics have been recklessly used for many years in cattle and poultry feed. This is again a preventive measure as cattle and poultry farming is done in very congested areas and use of antibiotics prevents the animals from falling sick. Also, the use of antibiotics has shown increase in meat production and thus people involved in animal husbandry keep using antibiotics for monetary benefits. With higher consumption of antibiotics through the food chain, the pathogenic microbes have more chances to become resistant due to the greater exposure they receive.
Urban hyper consciousness: The urban upper middle class population is also doing its negative bit by overusing antiseptic, antibacterial and disinfecting cosmetic and sanitary products unnecessarily. How can our bodies attain immunity if even a little exposure to germs is not allowed? After all, we are provided our own immunisation system by nature, and that works fine to a good extent.
The time has come to understand the adverse effects of overuse/misuse of any chemical entity on human existence. A hygienic life style with proper drainage and sanitation in and around our living spaces should become the prime concern especially in cities where extreme infrastructural changes are going on in the name of urban development. The over-use of antibiotics and pesticides Mass food production should get proper care on use of antibiotics and pesticides.
And above all, medical practitioners, pharmacists and patients should take responsibility for the proper use of medicinal drugs.
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Children should be taught to aspire to be successful, but success doesn't have to mean an IIT admission only!
Imagine studying for 2 or 3 or 4 or 5 whole years for the JEE exam only to find out that there’s only a very, very slim chance of getting into an IIT. It is a fact widely acknowledged that the IIT-JEE is one of the toughest exams not just in India but in the whole world. Apart from IITs, the NITs and IIITs of India also accept the JEE scores for admission. There are said to be a total of 23 IITs, 31 NITs and 25 IIITs across the country.
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So, it’s quite clear that the journey of making it through IIT is as challenging as the journey of getting into an IIT. Third and most important of all, the acceptance rate or the odds of getting into an IIT are below 3% which is a lot lower than the acceptance rate of highly and very highly ranked US universities. Four, getting into an IIT of one’s choice doesn’t mean one will also get into a branch of one’s preference at that IIT.
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