Urgent actions needed to combat "superbugs"
Several communicable diseases, notably those caused by bacteria have been with mankind since time immemorial. These continue to be important "public health threats". Typhoid fever, cholera, diarrhoeas and dysenteriae as well as pneumonia are caused by bacteria. They are responsible for substantial deaths, disease and economic loss in developing countries. Recent cholera outbreaks in Nepal, Pakistan, Congo and Haiti demonstrate the damage these organisms can cause to human health and well being. Frequently, novel types of a few well known pathogens also appear. Spread of Escherichia coli through the food chain in some of the most developed countries is just one example of international spread of bacterial infections. With growing institutional medical care, it is becoming increasingly difficult to make health facilities free from these pathogens. Hospital-associated infections have assumed serious proportions across the world. The environment in the hospitals is conducive to the propagation of various bacteria. Even the best patient care is at risk of being negated by hospital-associated infections. Often, these infections prove to be fatal because of their resistance to multiple drugs. The medical management of bacterial diseases was revolutionised about seven decades ago with the advent of antibiotics. These wonder drugs — appropriately called "magic bullets" — prevented deaths; as well as reduced the duration of illness, and the duration of communicability of killer diseases. Understandably, these powerful drugs became the mainstay in the battle against bacterial diseases. The modern advances in health care have benefitted tremendously from the effective use of antibiotics. But, unfortunately, resistance to these drugs has emerged, and is spreading. Infections caused by drug resistant bacteria fail to respond to treatment resulting in prolonged illness and greater risk of death. When infections become resistant to the "first-line" antimicrobials, treatment has to be switched to the second- or third-line drugs which are nearly always much more expensive, and sometimes more toxic as well. For example, the drugs needed for treatment of MDR-TB are over 100 times more expensive than the first line drugs. Multidrug-resistant bacteria are increasingly causing mortality, morbidity, and longer hospital stay as well, these organisms lead to the use of extremely expensive drugs in health care facilities. The consequences of antimicrobial resistance are severe indeed. Resistance in microorganisms costs money, livelihoods and lives and threatens to undermine the effectiveness of health care delivery programmes. Unless countered effectively, the bacterial resistance will accumulates the microorganisms resistant to "multiple drugs" appear, and these microorganisms will establish themselves as "superbugs". This phenomenon is only the tip of an iceberg, with a very complex causation. The World Health Organisation has developed a Regional Strategy for Prevention and Containment of Antimicrobial Resistance in South-East Asia. The strategy addresses issues pertaining, in particular in this endeavour, to governance, regulations, capacity building, and involvement of all stakeholders concerned. The global community has reached a stage, where preservation of the efficacy of the precious resource of antibiotics cannot be ignored any longer. The time for sustained and vigorous global action is now. It should be mindful that we are slowly, but surely, drifting towards a reversion to the dreadful pre-antibiotic era in which unacceptable mortality and morbidity come in a big way from untreatable bacterial infections that would pose the biggest threat to global health and the threat to our attempts to make this world a better and healthier place to live in. The writer is the Regional Director, WHO Regional Office for South-East Asia, New Delhi.
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