Infection causing micro-organisms e.g. bacteria, fungi etc have been an important health concern for a considerable time. With invention of microscope and identification of these disease causing organisms & later the accidental discovery of penicillin an antibiotic led to a major revolution in medical treatment.
Antibiotics changed the course of once untreatable diseases that were left to cure by the patients immune system itself, to being curable with a course of therapy for a few days. After penicillin several other antibiotics were discovered against a vast variety of bacteria. These infectious diseases which appeared to be finally under control, generated a particular concern few decades later, the medicine were fading in their efficacy the reason, Resistance.
Antibiotic resistance happens when bugs like bacteria and fungi develop the ability to fight off the drugs designed to terminate them. That means the germs are not killed and continue to grow. Infections caused by antibiotic-resistant germs are difficult, and sometimes impossible, to treat.
Antibiotics resistant strains e.g MRSA have been identified for quite some time, with several protocols in-place for screening, infection control & reserving high efficacy antiobiotic for use in severe diseases only.
A great health concern now currently being faced by the medics here in Pakistan is the increasing frequency of bacterial strains (referred as Superbugs) that are resistant to more than 2-3 broad spectrum antibiotics and of the most concern some are resistant to all the antibiotics available locally in Pakistan.
Recently an outbreak of Typhoid fever caused by a multidrug resistant strain of salmonella typhi bacteria, was isolated in Sindh, which raised alarm bells among the public as well as clinicians. Urinary tract infections e.g. Ecoli infection are also seeing multi drug resistant strains. Another bug that is also of particular concern is Mycobacterium tuberculosis that causes T.B, has also multi drug resistant strains.
Superbugs are becoming a significant health burden and needs urgent attention otherwise these diseases might become very difficult to treat.
Antibiotic stewardship is the most important part of the strategy in dealing with this issue.
Antibiotics should only be prescribed by a qualified doctor & on particular indication. The sale of antibiotics should also be restricted in pharmacies without prescription. Legal action should be taken against quacks.
In Pakistani hospitals the issues relating to infectious diseases & Antibiotic use are:
•Lack of local antibiograms
•Lack of or time consuming, Costly Culture and Sensitivity testing service.
•Lack of infection prevention awareness and practical protocols and equipment particularly by healthcate allied staff.
Public education and awareness regarding avoiding self medication, completing the full course period of the therapy, hand hygiene practices & not persuading for antibiotic therapy for minor ailments is also needed to counter this rapidly emerging health threat. As the development of new antibiotics is painfully slow process acompanied by regulatory and safety challenges, before it is available for public use.
