KARACHI: Antibiotics are losing their effectiveness at an alarmingly level across the world and lack of sufficient data on antibiotic resistance in countries like Pakistan doesn’t mean they are safe from the health crisis being experienced in many other parts of the world.

In fact, the scale of the disaster is estimated to be much higher in the countries with lack of basic amenities like clean drinking water, sanitation, infection control practices and, which have, high consumption rates of antibiotics.

This was stated by Dr Nizam Damani, a consultant at the WHO Global Infection Prevention and Control Unit in Geneva, Switzerland, while speaking to Dawn at a local hotel on Tuesday.

A Dow Medical College graduate who has extensive experience as an infection control expert, Dr Damani is currently visiting the city to attend the 32nd PMA Biennial Medical Conference starting on Nov 11.

“There is an immediate need that these countries have localised studies to determine the scale of this problem (antibiotic resistance). Often, the route of antibiotic-resistant infection has been traced out to developing countries,” citing some cases in which the infection was traced to India and Pakistan.

To a question, he said, antibiotics were losing their effectiveness at a rate that was both alarming and irreversible and the world was heading towards a post-antibiotic era in which there were widespread deaths from common infections.

“The crisis has occurred due to misuse and overuse of antibiotics, over the counter availability of antibiotics, counterfeit drugs, lack of good quality diagnostic facilities and use of broad spectrum antibiotics.

“In many settings, doctors are prescribing antibiotics without carrying out proper need assessment,” he said, adding that there was massive misuse of antibiotics in the livestock and agriculture sector, too.

According to him, some studies suggest that 20pc to 50pc use of antibiotics at hospitals and in communities (by general practitioners) is unnecessary whereas 40pc to 80pc use of antibiotics in the livestock sector is highly questionable.

“It also estimated that 10m deaths costing 66 trillion pounds will occur by 2050 if the world fails to address the problem,” he noted.

Lack of infection control practices at hospitals, he said, was a major factor contributing to the spread of antibiotic-resistant microbes and it was evaluated that over 1.4 million people worldwide were suffering from infections acquired in health-care facilities.

“With modern health-care facilities in the developed world, five to 10 percent of patients acquire one or more infections, while the risk of these infections is two to 20 times higher in developing countries. The proportion of patients affected by it can exceed 25pc,” he said.

‘Humans can win war’

On some antibiotic resistant microbes, he said, the the New Delhi metallo-lactamase-1(NDM-1), a potentially very dangerous bacterial strain resistant to even some of the most strongest antibiotics dangerous, was first identified in 2008 in a Swedish hospital where a patient from New Delhi, India, was admitted.

It caused an uproar in India for two reasons; the Indian government felt that the enzyme named NDM-1 was a national insult as it was named after the country’s capital and, more importantly, they also felt there is a plot to damage India’s fast-growing $2.4 billion per annum medical tourism industry.

“A few years ago, there was a countrywide outbreak of microbes that have developed resistance against Carbapenem (an antibiotic used for the treatment of infections known or suspected to be caused by multi-drug resistant bacteria) in Israeli hospitals, which was effectively controlled by the government,” he said.

According to him, the latest emergence of certain microbes having resistance against the ‘last resort antibiotics’ is a major health challenge that means that humans have lost the battle against microbes.

“But the war can be won through the prudent use of antibiotics; using narrow spectrum antibiotics and recommending the right antibiotic with the right dose, right time and right duration and checking its misuse in the livestock and agriculture.

“Community awareness about hygiene practices such as hand-washing and putting in place infection control measures at hospitals [can help prevent excessive use of antibiotics],” he said.

Published in Dawn, November 9th, 2016