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THE spectre of antibiotic resistance is looming large on public health horizons the world over. Two recent reports from the Centre for Disease Control and Prevention (CDC) and the World Health Organisation (WHO) have brought the menace of growing resistance to antibiotics into sharp policy focus.
The WHO report predicts that mortality from antibiotic resistance is set to grow if no remedial efforts are put in place soon. The scale of the problem can be gauged from the fact that even in medically advanced regions of the globe, where health systems are robust, the number of deaths is growing exponentially.
The WHO report estimates that in Europe 25,000 annual deaths are traceable to antibiotic resistance. The CDC estimates for the US are approximately 23,000 annual deaths, with loss to the economy put at more than $30 billion. This level of mortality in Europe and America is happening despite the prudent use of antibiotics as a matter of policy over decades.
For example, in the UK antibiotic use is 18.7 doses per 1,000 patients which is comparatively lower than in other European countries such as France and Greece. The threat of antibiotic resistance has caused such concern in Britain that the chief medical officer has recommended the threat of anti-microbial resistance to be included in the national risk register of civil emergencies.
It is worth recalling how we got to this tipping point. Until the 1950s, antibiotics were considered the most effective treatment to ward off microbial infection. The widespread use of antibiotics was instrumental in tackling head on the challenge of disease control and eradication ever since penicillin was discovered by Alexander Fleming. Yet, over time, new resistant infections have emerged putting the efficacy of antibiotics in question.
Antibiotics should be dispensed strictly by a certified doctor.
In fact, Fleming was the first one to point out the problem of growing resistance. That the problem has not been tackled also owes to the fact that the development of new antibiotics has not kept pace with the rate of new infections which is roughly one every year.
One major reason is the reluctance of pharmaceuticals to invest in new antibiotics which are not considered money spinners in the way drugs for chronic conditions such as heart ailments are. The result is a limited range of frontline antibiotics available to treat a growing range of infections. This calls for both a global and local response.
The problem is particularly bad in developing countries, according to the WHO report. Though no hard statistic is available for Pakistan, common knowledge of everyday medical practice, in both clinical and hospital settings, is enough to conclude that the practice of overprescribing medicines is widespread.
From different media reports, the number of medicines per prescription range from 2.8 to 4.5 which is way above the WHO-advised limit of two drugs per prescription. Furthermore, the practice of overprescribing is more prevalent in the private than the public sector.
This can be put down to the commercial and promotional influences of the drug industry in private healthcare systems where the purchasing capacity of service users is deemed higher than of those frequenting the public sector. And antibiotics figure largely in all the prescriptions. In most cases they can be avoided or rationed more carefully. Even in the US context the CDC report notes that 50pc of antibiotics are either not needed or not properly prescribed.
The situation in Pakistan is imaginably worse. Yet there is no national level investigation to look into the abuse of antibiotics and their long-term effects on the health security of the nation. Here the issues of patient safety and the health protection of millions with ailments are paramount too. Pakistan can only ignore this creeping and silent crisis at its peril.
This crisis assumes menacing proportions when we consider the unethical practices of the market which is flooded with over-registered, often substandard, medicines.
The fightback has to begin with prudent and restrained use of available antibiotics. This can be managed by strictly regulating the prescription of antibiotics with health guidelines setting down the clinical conditions and the correct dosage of antibiotics, to be prescribed when absolutely needed. Alongside this, antibiotics should be dispensed strictly on a certified doctor’s prescription.
The government should also undertake an awareness campaign, aimed both at patients and doctors, highlighting the dangerous long-term anti-microbial resistance outcome of the overuse of antibiotics. More importantly, the pharmaceutical industry needs to be incentivised to invest more in the development of new antibiotics.
Unless these measures are adopted, and backed by the full force of the law and regulatory oversight, we will see more deaths on account of anti-microbial resistance than perhaps from any other single cause.
The writer is an Islamabad-based development consultant and policy analyst.
Published in Dawn, November 30th , 2014
