A microbe is a living organism which cannot be seen with the naked eye (without using a microscope). Microbes may be beneficial or harmful to the human. Bacteria, fungi, virus and protozoa all are microbes. The microbe which causes disease is called a pathogen.For example,Mycobacterium tuberculosis (Bacteria) causes tuberculosis (TB) in humans,Polio virus causes polio in humans, Plasmodium falciparum (protozoanparasite) causes malaria.The drugs used to kill or inhibit the growth of these pathogens are called antimicrobials.
When a pathogen resists the effect of a previously effective antimicrobial agent, the phenomenon is called as antimicrobial resistance. The emergence of antimicrobial resistance in pathogens has increased the morbidity and mortality rates of patients worldwide. Common diseases which were easy to cure some decades ago have become more problematic and life threatening. Antimicrobial drugs are of several types which include antibiotics, antifungals, antiparasitic and antivirals. Most commonly used antimicrobial drugs are antibiotics which are used to kill or inhibit the growth of bacteria. Some examples of antibiotics include amoxycillin, streptomycin, erythromycin etc. Antibiotics play a major role in the treatment of infectious diseases in humans and domestic animals. Without antibiotics, the control of infections caused by both common and rare bacteria would be really difficult. If antibiotics were not there to cure the bacterial infections,a part of world population would die of infections. Thus, antibiotics have played and are still playing an essential role as life savers for the human population.
Resistance in bacteria towards the commonly used antibiotics has emerged which is making the treatment of otherwise easily curable infectionsmore difficult. This results in increased stay in hospitals, increased expenses and chances of nosocomial infections.The most common causes of emergence of antibiotic resistance in an organism include un-prescribed use of antibiotics, use of left-over antibiotics, using antibiotics against viral infections, not completingthe full course of antibiotics and continuing antibiotics even after the completion of course.All these practices impel the pathogenic bacteria to evolve certain genes responsible for antibiotic resistance.Or else, these genes can be obtained from the other ‘already resistant’ bacteria by genetic recombination(s).So, the next generations of those bacteria become habitual to the misused antibioticand won’t be killed by the same.Due to the emergence of antimicrobial resistance, diseases caused by pathogens such as Mycobacterium tuberculosis (TB), Leishmaniadonovani (Leishmaniasis), Klebsiellapneumoniae(Pneumonia), Pseudomonas aeruginosa (UTIs) have become more life threatening than before. The antimicrobials which are most commonly used without proper prescription include amoxycillin, azithromycin, ciprofloxacin and metronidazole.
Antimicrobials should not be taken without prescription of a certified doctor. Also, there should be a proper procedure to prescribe an antibiotic. In the Department of Microbiology, Indira Gandhi Medical College and Hospital, Shimla a very refined procedure is followed before prescribing an antibiotic to the patient. For example, if a patient has severe throat infection, a throat swab from that patient is received in our department. It is then cultured on suitable media to grow the infectious agent responsible for throat infection. Next day the infectious agent/bacteriais identified using various methods. Subsequently, it is subjected to Antimicrobial Susceptibility Testing (AST) which tells us the most suitable antibiotic for that particular strain of bacteria isolated from the infection site. Commonly, seven antibiotics are tested simultaneously for each bacterial strain. The doctor then prescribes the antibiotic showing highest activity against that particular bacterial strain. This is the proper procedure which should be followed in all the government health centres all over the country. The plate in figure 1 is showing that out of seven tested antibiotics, only three were active against this bacterial strain. Cefoxitin (in the center) has shown the maximum inhibitory activity followed by tobramycin. Thus, cefoxitin would be prescribed for the patient from whom this isolate was obtained. The four drugs for which this bacterial strainis resistant will not cure the patient even if he takes those four antibiotics for a really long time.
We conducted a survey in our department to get the information about the knowledge of the citizens of Himachal Pradesh about antibiotic resistance. Himachal Pradesh is 11th most educated state in India with a literacy rate of 82.80%. Indira Gandhi Medical College and Hospital is the oldest medical college and hospital in Himachal Pradesh. From our survey we found that, out of 430 patients, only 80 (18.6%) had heard about antibiotic resistance. If these are the results in a state with 82.80% literacy rate, what would be the picture in the other states?
Our country has no law against the sale of antibiotics without prescription, whereas in some states the sale of sedative drugs is banned by state/central government. The central government should take some steps forward to minimize the sale of antibiotics without proper prescription which will help to some extent in controlling the antibiotic resistance in our country. Till then, people for their own benefit should not consume antibiotics without prescription of a doctor or else the small microscopic super-bugs will become really nasty and may make them sick for long time.