Anjali Joshi

The accidental discovery of Penicillin in 1928 was a pivotal moment in modern medicine. It was suddenly possible to treat literally millions of infectious diseases afflicting mankind – diseases that had up to that point, been a death sentence. And thus, began the age of the cure-all miracle drugs called antibiotics.
However, their convenience of administration and ease of availability brought about their abuse – not only by the general population but also by medical personnel. And now, following years of misuse and abuse of antibiotics, the world is facing a grave new crisis of antibiotic resistance.
Antibiotic resistance is the ability of bacteria and other microorganisms to resist the effects of an antibiotic to which they were once sensitive. According to World Health Organisation, antibiotic resistance is one of the biggest threats to global health, food security and development today.
Every time someone takes antibiotics, the weak bacteria are killed but some strong ones survive. The surviving bacteria then unfortunately mutate and develop a resistance to the same antibiotic. This, in turn, means that the same medicine will have little to no effect on them in the future. Such development of resistance to antibiotics is a natural phenomenon but the rampant abuse of antibiotics going on today has accelerated its pace and is starting to emerge as a frightening public health hazard. Because such antibiotic resistant bacteria doen’t just limit themselves to their host individual. They get transmitted from one person to another until we have a whole population infected with “superbugs” that cannot be cured by the medicines at our disposal.
Now, it would be ignorant to solely blame people for this crisis. They don’t know any better. But doctors and medical professionals do. Yet, they continue administering more than one antibiotic without antibiotic susceptibility test. Still, doctors find it way too convenient to prescribe antibiotics as umbrella drugs to “easily cure” anything and everything that might be ailing the patient. But at the same time, we cannot acquit the abusive practices of people as well. People often do not complete the dosage of antibiotics prescribed to them after their symptoms disappear; even in serious cases like Tuberculosis and Pneumonia. They do not take their medicines in time and often mix them up. They do not consult their prescribing doctor and miss crucial check-ups.
The practice of buying medicine with the pharmacists without any consultation with a physician is also a big culprit in increasing the problem in our part of the world. Not all people who sit behind the counters of pharmacies have a formal degree in pharmacy. Hence, they tend to misdiagnose a number of diseases. Similarly, a number of pharmacists sell antibiotics even when the person is suffering from viral conditions such as cough, cold and flu. The patients, in this case, do not require any medication and usually are healed within 7-10 days simply by taking rest and drinking fluids
But the biggest culprit of all is the practice of shooting up of our animals with antibiotics – especially chicken. Farmers overdose their animals with a concoction of antibiotics to prevent any infection and make them ‘meatier’ and more profitable for selling. But, when consumed, these drugged up animals expose the people to all these antibiotics that they, then, develop immunity to. In Nepal, Department of Livestock Services has restricted the import of feed supplements containing antibiotics since 2016 which is a step in the right direction. However, there are no significant data that show whether the policy is being implemented or not.
But still, antibiotic resistance wouldn’t pose such a huge problem if only new and stronger antibiotics could be developed/ discovered frequently. But it is not so easy. Almost all the antibiotics that are available in the market today are some variation of the antibiotics discovered in 1984. The antibiotics used to treat gram-negative bacteria were developed in 1962. The long and arduous path from the discovery of an antibiotic to its clinical approval coupled with its high failure rate means new antibiotics come in the market only one or twice a century. So we do not have the luxury of allowing our present drugs become redundant in hopes of something bigger and better to come along – simply because it won’t.
Hence, the only plausible way we tackle this challenge is by regulating the prescription and administration of antibiotics. It is paramount to teach everyone that not every disease requires antibiotics and when the ones that do, require them fully i.e. people should complete the dosage. The ethical use of antibiotics aids in minimising the pain and suffering of animals and the consumption of animal products after withdrawal period (the time taken for the antibiotics to be cleared from the animal’s system) will not increase the problem of resistance.
Hence, policies should be made and implemented strictly so as to discourage self-medication of antibiotics to livestock and surveillance of animal under medication so as to prevent the consumption of animal products before the withdrawal period.

(Joshi is a 3rd Year MBBS student at Kathmandu Medical College and Teaching Hospital, Kathmandu)