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Antibiotic Resistance Sounds an Alarm

by Professor Sheikh Nesaruddin Ahmed and Dr Zulfiquer Ahmed Amin
People suffer from dta re* mostly dur to ass notation of some micro organisms Amongst these micro or^xnlsms. bacteria are the number one for disease procedure To prevent or restrict growth of bacteria, antibiotics were Invented Before Invention of antibiotics, death from different disease were several folds than today, which reflects association of bacteria tn disease production and great contribution of antibiotics to reducing mortality and morbidity rates worldwide
Now-a days. It is a concern of all doctors tn private practice or hospital level for treat Ing bacterial Infection mostly because of bacterial resistance to antibiotic. That Implies bacterial which were originally sensitive to an antibiotic have become resistant to tt so that they grow even when It is present. Resistance can most easily be demonstrated In the laboratory by culture sensitivity test but It may also be seen chnicalty because the drug has little or no effect on the infection Bacteria reproduce rapidly and fhetr genetic material may alter slightly with each new generation, producing new and accidental muta tton. Some of these changes enable them to survive better. When antibiotics are given, the more sensitive bacteria) arc rapidly eliminated. Strains that become genetically resistant to a particular antibiotic are likely to become more numerous than those which arc sensitive. There are two categories of drug resistant mechanisms.
A. Drug tolerance occurs when the bacterial change their structure or function so that they are less vulnerable to an antibiotic
B. Drug Destroying bacteria have adapted in a tgpy that reduces and antibiotic's effectiveness Some resistant strains produce an enzyme that inactivates the antibiotic — for example, certain bacterial produce beta lactamase which destroys some kinds of penicillin.
Many examples of drug re sistance are faced by the doctors and public health workers now a days fn all arc as of health practice. In most of the developing and under dew! oped nations In the world, causing difficulty In disease elimination and suffering of pa ttents to buy expensive and unavailable antimicrobials Where resistance develops, it can be difficult to treat bacte
rial Infections — particularly with the drug which are avail able and affordable. We cannot always be sure that new. equally effective drugs will become available. When they do, they are usually expensive.
Studies have been carried out tn different countries on antibiotic resistance. Information from the studies has given an alarming sign to all to how many strains of bacteria either drug-tolerant or drug destroying which have caused to change rationally used antibiotics for a particular bacteria. So ft has become obligatory to replace some other regimens not so available and affordable to linger the disease procedure and has put an extra burden of expenditure on the patient. A recent study tn I’uklsliui reveals a horrifying Increase tn the resistance of streptococcal-pneumonia to antibiotic which produces
pneumonia. From 1986 to 1989 researchers examined blood taken froth 167 children with acute lower respiratory tract infection that contained S Pneumonia More than 20 strains or serotypes were iso la ted. identified and tested for their sensitivity to a range of antimicrobials Laboratory test showed that over 95% of the Isolates had decreased sensitivity to penicillin. Over the four years, nearly half of the isolates were fully resistant to cotratmoxazoie. the drug of choice for acute respiratory tract infection (ARI)) programme in Pakistan and most of the remainder had de -creased sensitivity Prevalence of cotralmoxaaoie resistance has also been found among 8 Pneumonia Isolates in Saudi Arabia (55 per cent) and Spain (52 67 per cent) Cotrimoxazoie Is recom mended for ARI programme because of Its low cost com pared with Procaine penicillin and oral penicillin Over 500 isolates from 1 1 countries were tested with 1 I antibiotics for Antimicrobial resistance of H Influenza. The countries included Argentina. Bangladesh. Brazil. Kenya. Pakistan. Papua New Guinea. Philippines and Thailand This studv was sup ported by the Board of Science and Technology for International development (BOSTID) In collaboration with the US National Academy of Science It showed 6% of H Influenza strains were reals tant to Ampicillin and/or Penicillin
For the purpose of this aril cle. another study was carried out in Dhaka Medical CoOegr Hospital tn surgical wards 10 cases of abscess In different parts of body culture yielding . SiaphyUococcus Aureus as the causative organism were exam Ined in this study. Out of these patients under study. 7 were resistant to ampicillin. 5 to Cloxacillin, 5 to. Amoxycillin. 6 to Tetracycline. 3 Doxacycllne 3 to Ccphalesin. 4 to Colrtmoxazole. 2 to Gentamycin. only 2 groups of antibiotics were fully sensitive in this study group and these were Nalldlcls acid, ciprocin.
Antibiotic are often pre scribed unnecessarily by poorly informed doctors People may buy antibiotic from pharma cists and other drug sellers without prescriptions and use them when they are neither necessary nor likely to be ef fectlve. It Is easy to buy any kind of drugs without a pre scriptton from private phar macles. The red warning on drug packages which reads
SOLD UNDER MEDICAL PRESCRIPTION seems to be little more than a decoration. Even when an antibiotic is appropriate. people may not un derstand why a full course Is needed to complete the cure. They may be tempted to lake less of the drug if It is cheaper for them to buy less or to save
some of the course for the next occasion. Many people, both Htsrate and illiterate, simply refuse to take the ad vice of doctors for prescriptton to save the money and consult with compounder for medicine The compounders understand the psychology of this group of patients and give drugs which only rehves the symptoms of the disease but cannot cure it. Some com pounders give incomplete course of antibiotic for convenience of patient and buy at a cheap coot. Such over pre serfoing and misuse of antibi-olks contribute to the growing problems of resistance.
Now the question is how we can prevent this resistance to antibiotic. The simple answer is the correct use of antibiotics
I Antibiotics should never be used unless they are needed Resistance becomes more likely when the bacteria are given greater exposure to
2 Antibiotics should always be taken tn right dose and for the recommended length of time Stopping taking the drug early helps resistance to de velop and symptoms may re turn because the bacteria are able to grow again.
Now the question Iles how we can Implement it. To prevent further antibiotic rests lance, everybody concerned with public health must be conscious about It. Doctors should do what they are sup posed to do. Patients should never take any antibiotic with out prescription None should take the risk of prescribing an tlbtotlcs without sound knowi edge of pharmacology and therapeutics. As Socto-eco nomic status of most of the Third World nations cannot fund for adequate health policy and health faculties. So private pharmacies are often the only option for those seeking treatment. Considering this. WHO has recommended that first level health workers be trained Io diagnose disease, to treat tt appropriately with an tlbtotlcs if required and refer severe cases. Il would be both available and affordable for the patients and thereby we can get rid of this alarming situation of antibiotic resistance