Growing ANTIMICROBIAL RESISTANCE to all Antibiotics and all the CHARCHA ( discussion ) around this phenomenon has been the Talk of the Town in the last decade.
The frequent Lectures and Orations on this subject often imparted an overwhelming GUILT FEELING in the broader Medico Community, that they have been CARELESS and IRRATIONAL in their therapeutic usage of available Antibiotics. This is FAR FROM THE TRUTH and this Blog is dedicated to showcasing the TWO CONTRASTING SIDES OF THE COIN for a future perspective – full of sanity and scientific logic.
This burning issue is also amongst the TOP TEN CONCERNS of the World Health Organization .
The FIRST SIDE of the AMR COIN :
( AMR meaning Antimicrobial Resistance.)
All the pathogenic Bacteria are inherently SMART BUGS, having an intense desire to survive by staying fit . They have genuinely imbibed the universal concept of : SURVIVAL OF THE FITTEST
Their Modus Operandi is disclosed here :
They have immense Genetic Plasticity to trigger specific responses to any external challenges ( Antibiotics included ) by making MUTATIONAL ADAPTATIONS, Acquisition of genetic material or Alteration of gene expressions. These defense mechanisms could be designed to achieve, either of these :
1. To decrease the affinity for the drug.
2 . To decrease uptake of the offensive drug.
3 . Efflux mechanisms to pump out the harmful antibiotics.
4 . Enzyme Inactivation of the specific antimicrobial agent , by namely – Beta-lactamases, ESBL , Amp-C and NDM beta-lactamases, Carbapenemases, and so on… These enzymes are the new metabolic pathways derived to transform the drug molecule and its efficacy.
Therefore, the important facet of the AMR COIN is the SMARTNESS and inner POTENTIAL of these Bacteria, to adapt to newer Antibiotics, over a brief time period.
SECOND SIDE of the AMR COIN
What is traditionally assigned, to all the Doctors, is the way we use these Antibiotics in real life. Agreed that Antibiotic OVERUSE is the biggest driver of AMR, for the following seven reasons :
1 . Empirical use of Antibiotics in most cases of FEVER, without defining a clinically established focus.
2. Poor Lab. Testing facilities for suspected Viral infections.
3. Self Medications by patients, because of OTC purchases, easily availed without a fresh prescription.
4. AYUSH doctors and so called Quacks dispensing Allopathic Medicines ( Antibiotics included )
5 . Incorrect DOSES of Antibiotics and timing irregularities in Antibiotic ingestion by our patients.
6 . Sick Children are most uncooperative in taking timely medications.
7 . Finally, lack of good Infection Control Practices, Vaccine Hesitancy, sub-optimal Sanitation and Personal Hygiene amongst the deprived masses.
DISCLAIMER :
AMR is a gigantic and a most challenging Medical Problem, across the globe and it is fuelled by these diagonally opposite factors, showcased by me – on both sides of the AMR COIN – the first one is obviously INHERENT and the second one is caused by the EXTERNAL TRIAD – constituted by the Patients , Society and the Practising Doctors.
Conclusion :
AMR is a natural phenomenon, which is aggravated by :
* un-indicated antibiotic usage
* low-quality medicines and
* wrong prescriptions.
Taking the entire guilt on our shoulders ( as Allopathy Practitioners ) is a silly mistake, that this Blog attempts to demystify.