Antibiotics Abuse and Misuse: A Menace to the Society -By Najeeb Maigatari

We are fast losing the war against microbes. These microbes are the fungi, viruses, protozoa and bacteria. Until now, we have had an upper hand in the fight against these microscopic inhabitants of our society, which when they live within our body, and they in fact do as normal floras, they serve a friendly purpose; but when a favorable condition for their pathogenicity is created in the blink of an eye they turn into daring enemies. This, however, does not mean that they are always found as normal flora of the body and capable of causing infections only when condition favors their pathogenicity; uncountable strains of these microbes live virtually on everything that surrounds our environment and can invade human body, evade its defense mechanisms and cause infection.

My article today will focus on the excessive misuse and abuse of Antibiotics in our society, a category of anti microbial drugs used mainly in the treatment of bacterial infections. Because of their affordability, and the fact that they are mostly found as over the counter medications, antibiotics are among the most commonly abused-and misused (which I will shortly explain how)-drugs in such societies where medical directives and pharmaceutical guidelines are of no regard.

Drug abuse, as generally known, is the taking of drug (antibiotic in this regard) without prescription from a qualified medical practitioner (mainly a doctor). Drug misuse differs from abuse in such a way that here the drug is prescribed by a qualified practitioner but is not taken as per the directives of the practitioner.

It is thanks to the great work of the 20th century scientist A. Fleming, whom introduced the first ever antibiotic (penicillin) that bacteria is forced to succumb to the over a century long war. Gone are the days when a simple bacterial infection (sore throat for example) have had the potential to wipe out an entire community of people from the face of the earth. Antibiotics changed all of that in history. But today, due to our continued misuse of the same antibiotics, we are fast turning back the clock of history in such a way that bacterial infections are becoming no longer treatable-including the simple ones, and death as a consequence of our action is on the rise especially among children population.

One such consequence is the alarming increase in antimicrobial resistance (AMR), which according to the world health organization is posing a great danger to the survival of mankind. In medical science, antimicrobial resistance is when a drug loses its effectiveness in the treatment of a particular strain of microbial organism (which it prior used to be). In this regard, and for our general understanding, AMR can be seen as the failure of antibacterial medication to treat infection which it otherwise used to treat; or the bacteria has developed resistance to the medication, simply put. This resistance is believed to be brought about by chains of mutation in the bacterial genetic material (DNA) whenever certain medication is not properly used which in turn alters its pharmacodynamics (how the drug works in the body).

As a result of this resistance, various strains of virulent bacteria are evolving and other known strains are not responding to their erstwhile medications. Take for example Staphylococcus Aureus, a bacterial flora found in the skin mainly, respiratory and urinary tracts. This erewhile penicillin-treatable bacteria is accounting for up to 80% of skin infections which could now no longer be treated by the same penicillin medication. The same staph. Aureus, one could understand, causes respiratory and urinary tract infections which could now be treated only by the use of combined, often broad spectrum, antibiotics. 

Another example here is Methicillin Resistant Staph. Aureus (MRSA), which doctors and medical microbiologists believed that it evolved as a result of irrational use of these antibiotics, in both hospital and community settings, which poses great danger to the society as it is one of the leading cause of hospital/community acquired pneumonia, a common disease in children. It could be treated by the use of Vancomycin (another antibiotic of different group from methicillin) until when, recently, a more virulent and by far more dangerous strain Vancomycin Resistant Staph. Aureus (VRSA) emerged.

It is no surprise when in addition, lately, doctors received the shock of their lives upon realizing that gram negative cocci which are implicated in gastrointestinal infections (mainly in the stomach and small intestine) have started to exhibit relative resistance to the almighty quinolone antibiotics which are mainstay in the treatment of various such infections as typhoid, gastritis (inflammation of the stomach lining) and etc. This, needless to mention that it is not up to a decade since doctors realized that another bacteria Helicobacter Pylori whose role in inducing gastro-duodenal ulcer is, alongside excessive use of non steroidal anti inflammatory drugs (NSAIDS), partly attributed to improper use of antibiotics in the treatment of other GIT infections.

Another consequence which is mostly seen in people who abuse antibiotics is the derangement of various metabolic functions. Bacterial flora found in the intestine help human, in a symbiotic relationship, to synthesize vitamin K which is a co-factor for various clotting proteins in the body. These proteins helps to prevent excessive bleed from injuries. Not only this, a significant population of these mutually living bacteria situated in various organs of the body are eliminated if antibiotics are irrationally used, which adds to the furtherance of impaired metabolic function. Moreover, the normal flora occasionally helps the immune system of the body to fight off foreign microbial invasion, a function which is also diminished by excessive use of antibiotics.

Unfortunately today, so many a great number of people have fall victims of one of the either practices. A semi-literate individual is now content to taking antibiotics for every variety of infection he may develop, the reason being he knows that they are used in the treatment of microbial infections. This can be seen in the society as many people tend to take antibiotics to, unfortunately, treat various such viral infections as the flu (influenza), herpetic lesions and etc. More disturbing is going too far as taking antibiotics for the treatment of such allergic conditions as runny nose (allergic rhinitis) which may not always be infectious, and if in case it is, viruses are mostly implicated.

Another category of people who misuse antibiotics a great deal are those who, perhaps, wanted to surprise bacteria by taking the medication not at the advised time, those who tend to increase or decrease the doses, and those who fail to complete the regimen (when they start getting better).  These when combined all together paved way for the development of bacterial resistance. Knowingly or unknowingly, we have for the last few decades brought upon our body’s immune cells (soldiers that fight infections, literally) a deplorable weakness which if not addressed properly, we imminently have to lose the ground to the microbes. And there it is, a self-defeat! 

To curtail this menace, the world health organization has put forth various regional strategies to ensure that this habit is checkmated once and for all. Some of these strategies include mass education and community awareness on the safe use of antibiotics, employing regulatory guidelines that ensures appropriate prescription of these drugs, only when necessary required, by medical practitioners and the move to re-categorize them from over the counter to prescription only medications.

Humans have suffered a great deal during the pre-antibiotic era, history has recorded how for example, a whole hunter-gatherer community in North America was wiped out of existence as a result of simple bacterial infection. Antibiotics are our last hope and only weapon in this war, but if things continue going at the current pace the same antibiotics, if not used wisely and appropriately, could take us back to right where we have started, and this time all alone by our pity selves! PLEASE use antibiotics only when necessary and as advised by qualified medical practitioners; if not for ourselves, at least for the next generations to come..

Najeeb Maigatari is a fourth year medical student at JXUTCM, China and could be reached at Maigatari313@gmail.com