Yesterday I was at Sarit and I saw a young boy crying frantically at the sweets shop. He wanted sweets but the mother was busy shopping for jewelry at the next shop. He was very ambitious in his crying and knew that if he just cried a bit louder and a bit more, the mother would give in and he’ll get what he wants. He did. Just to silence him, the mother bought him some chocolates and almost immediately, he stopped crying and was all smiles. Easy solution, right?
Similarly, a Kenyan mother was woken up in the middle of the night by the racking coughs of her daughter. She comforted the child, gave her 5 ml of antibiotics syrup that she had in the cupboard, and went back to bed feeling accomplished, and assured that the child will feel better. The next morning she walked into a pharmacy, purchased more of the antibiotic syrup and continued the antibiotics for another 3 days without using the prescribed dosage or frequency. Once the cough had subsided, she stopped.
In contrast, another mother in Amsterdam woke up in the night under similar circumstances. She gave her daughter an inhaler and saline nasal drops to alleviate the cough, and the next morning she visited her doctor who advised that that was a viral infection, not needing antibiotics and discharged the child on treatment to manage the symptoms. Unfortunately for her, she is unable to get any over the counter antibiotics from the pharmacy.
In the first case, the most likely cause of the cough was probably a viral infection and the antibiotics were probably not necessary.
Antibiotics work by destroying the structure of the bacteria and by stopping the bacteria to work well, leaving it to die off.
Nevertheless, as bacteria are exposed more to antibiotics, they develop their own mechanisms to survive attack by antibiotics. This is called resistance. Antibiotics only kill the susceptible bacteria, leaving the ones not affected. This creates a process of natural selection. Unfortunately, out of ignorance, we are helping bacteria to develop more and more resistance.
Bacteria resistance is developing rapidly and we now have some bacteria that can only be killed by one antibiotic, and some by none. Illness from one of these bacteria would almost certainly mean death as the ability to develop new antibiotics is now quite limited.
What are the factors leading to increased antibiotic resistance?
- Frequent and widespread misuse of antibiotics for the wrong reasons.
- Use of antibiotics for the wrong infections (viral or parasitic)
- Not completing the full course of antibiotics
- Taking antibiotics at a lower non-effective dose
- Use of poor quality antibiotics.
- Improper use of antibiotics in the clinical setting
- Increasing development of severe bacterial infections in vulnerable populations e.g. immunocompromised persons
Each of us has the ability to address number 1 immediately. How do we do this?
- We must avoid antibiotic use unless directed by a doctor. Viruses cause most of the cases of the common flu and cough we acquire frequently. Antibiotics only work on bacteria, not viruses.
- Purchase of antibiotics over the counter, for actual or perceived bacterial infections is a leading cause of resistance development. Without the guidance of an understanding medical professional, one could use antibiotics that are not effective against the infection they have.
- We should be especially careful about giving antibiotics to our children. Most of us did not grow up with easy access to antibiotics, but many of our children have been over-exposed since birth. We might be bestowing upon them a very difficult future.
Implications of Antibiotic Resistance
Morbidity: An infection that is not controlled leads to gradual breakdown of the body’s normal processes. After spreading to involve the whole body, it then gradually causes failure of the main systems such as the breathing, blood pressure, kidney function, even brain function. This is why patients with sever infection need Intensive Care Unit (ICU) care.
Mortality: According to the WHO, there are 440,000 new cases of multi-drug resistance, and 150,000 associated deaths in the treatment of pulmonary tuberculosis. Please note that this is just one bacterium.
Cost: When one gets a super bug infection, the antibiotics that can cure them could cost up to Ksh 20,000 per dose, and need to be imported. When one has to take two doses every day for 10 to 14 days, the total cost could come to Ksh 560,000. Only for one medication, that is not guaranteed to work.