ANTIBIOTIC CRISIS
Posted by bmhegde on 1
Nearly seventy years ago, when Alexander Fleming and Prof.Florey discovered a mouldy growth on their culture plates to be a powerful antibiotic, penicillin, a new era began in medicine. The predictions then were, as usual, that the end of man’s fight against germs on this planet is drawing closer. Like all other predictions in linear science this one has also been proven wrong. Doctors have been predicting the unpredictable all these years. That in itself is not bad! But we are now facing a new and formidable threat in that many of the germs that were initially sensitive to antibiotics have now become resistant and threaten to annihilate man from this planet. One example would suffice. One common germ, the streptococcus, was the most sensitive germ to be killed by penicillin. While 95% of these germs could be easily killed by penicillin to begin with, today 95% of the same is resistant to penicillin.
The history of this universe is very closely connected to human births and deaths, but illnesses do change history much more dramatically compared to the former two. The black death due to plague in Europe in the sixteenth century, the white death- so called because it killed most people with extreme anaemia and mostly young adolescents in particular- of tuberculosis, have been the greatest tragedies of mankind. Tuberculosis still eludes a cure despite our euphoria after the advent of antibiotics against the germ mycobacterium tuberculosis.
In fact, it has become much more rampant and dangerous now that AIDS abets and assists tuberculosis to ravage human life. Tuberculosis has assumed a different form these days because of the changing circumstances. Historical milestones of tuberculosis include the hunchbacks of Egyptian mummies, the phthisis (wasting) of the Greeks, and the English consumption for the lay public. Most diseases respected wealth and status to a certain extent, but plague and TB did play truant with even the rich and the famous from time to time.
The gravity of the situation is such that the Royal College of Physicians of London organized a meet to discuss the Clinical Implications of Anti-microbial Resistance on the 28th February 2001. It has been estimated that around 15,000 people die in that small country every year from infections against which no antibiotic is effective. Such of those germs that are resistant to most antibiotics are called the super bugs and, as of now, we have no defense against them. One of the biggest hospitals in that country, Portsmouth Hospitals NHS Trust, has been forced to shut down most of its operating theatres last summer because of super bugs there.At the Queen Alexandra Hospital the orthopaedic surgeons could not perform any operation around that time. Another leading authority in the field, Professor Hugh Pennington of Aberdeen University, feels that the next big problem would be that of drug resistant tuberculosis. They had an outbreak of TB in Scotland recently, traced to a travelling family. He also feels that the Russian prisons have many inmates who have drug resistant TB without proper treatment. Since TB does not respect geographic borders this time bomb might explode anytime anywhere!
The usual thinking in the West was that this kind of uncontrolled infectious disease scenario could exist only in the poor countries like India and sub-Saharan Africa. They are now in for a great shock. In a well researched book, Betrayal of Trust: The Collapse of Global Public Health, Laurie Garrett from the USA, shows how the threat is not confined to the poor countries but, is greater in the West, basically because doctors there over-prescribe antibiotics so that bacterial infectionsare becoming increasingly resistant to the most widely used antibiotics. She writes that "doctors who over-prescribe antibiotics undermine the health care system by encouraging germs to become resistant." She is dead right there.
The blame must also come on the consumers, the patients, as many of the latter, who think that they are well informed, demand antibiotics for the common trivial infections, most of which are viral to begin with. This adds to the problem. Doctors who follow ethics and refuse to give antibiotics are not usually popular. The fear of losing the patients makes many doctors to oblige patients with over-prescribing. Educating the public about the serious dangers of taking antibiotics for minor infections against medical advice should go a long way in reducing this menace.
Studies have shown in the USA that it is the rich kids that suffer more from ear infections and other common childhood infections. Since antibiotics are very expensive the poor parents do not bother to give their children antibiotics for minor illnesses. This helps the child to fight the infection with the help of its own immune system and, in the bargain; the child develops immunity against major infections. This has another very dangerous ramification to it. Antibiotics given to minor viral illnesses of childhood make the immune system change its response to infection in such a way that the cytokine response to infections, based on their genes, changes from TH1 to TH2. The latter is the most important trigger for asthma in later life. The slum dwellers kids, when they have enough to eat, have very robust health and have very low incidence of asthma and many other common illnesses. Whenever they do not thrive, it is only because they do not get enough nutrition intheir diet.
The other dangers of antibiotics are in commercial fields like farming and the diary industry. Broiler sheds use a lot of antibiotics to not only treat the infections in chicks but also in the fond hope of preventing infections in them.The amount of antibiotics used in cattle and broiler sheds far outweighs all that is used in hospitals and operation theatres! Today it only takes six weeks to get a bird on the dining table from the egg stage, about half the time normally required. The farmers, therefore, make double money and the birds come cheaper.But it means that we get a huge dose of antibiotics each time we bite a chicken lollypop! This does not take into account the added hazards of excessive hormones fed to fatten the birds. In short, we are only eating a slow poison.
Mastitis in cows is another danger. The incidence is around 10% of the cows in a diary on a given day! The huge amount of antibiotics, like ciprofloxacin, injected into the udder (one udder dose costs Indian rupees 8,000) makes the milk not potable for a week. But the farmers might use the milk earlier to reduce loss of money. So the milk that we drink from large pools in larger diaries might also contain unacceptable doses of antibiotics.
The House of Lords in Britain was worried about the large scale abuse of antibiotics in farming and spoke of a "vicious circle repeatedly witnessed in which the value of each new antibiotic has been progressively eroded by resistance." Very dangerous indeed. In a shocking incidence recently at the Prince Edward Hospital in Wales a patient had an infection in his leg wherein the germs were resistant to all the antibiotics available. Doctors had to go back to Nature to get maggots to help cure that infection! Now they are routinely culturing maggots to treat resistant infections there. In Nature this is a very common way of controlling bacterial infections, evident even during the Second World War.
Minor wounds could be smeared with fresh, clean honey. Honey gives a coating to the wound to prevent germs getting in and the germs already there are prevented from multiplying, as honey stops the nutrition needed for growth and multiplication in the germ world. Therefore the existing germs die out and the new ones can not get in.
The time bomb of tuberculosis is threatening to burst anytime now. The West is in the middle of the worst TB epidemic in the last twenty years. Tuberculosis never went away. It was only lying low because we depended on the powers of the anti-TB antibiotics too much and did away with the methods to enhance the capacity of the immune system as we used to do before the advent of antibiotics. Sanatoria, good food, complete rest, and a healthy environment were given up as useless. Surgery, which in the olden days, helped to get rid of the infected part of the lung, thereby reducing the risk of death and bleeding, took a back seat. Now we are threatened by the MDR, multiple drugs resistant germs of this deadly disease, waiting to produce another epidemic of the white death. Thomas Dormandy in his treatise The White Death (The Hambledon Press) gives us the horror stories of the hoary past with even people like Napoleon Bonaparte having suffered its ravages.
TB is no respecter of status or position and even money power for that matter. Many were the victims such as leaders, poets (Keats was the leading one), writers, soldiers, beggars, children, adults, mothers and also the medical and the nursing professionals. Many careers had to be either terminated or changed in mid-waters when TB struck. Things could be gloomier with the added burden of AIDS reducing the potency of the immune system of man. Vaccination against TB came and went without much fanfare. May be we need to look more carefully into this aspect of TB prevention. One could go on and on but the moral of the story is that to try and go against nature by producing antibiotics to kill germs in not going to succeed as the germs mutate to teach us a lesson. We must look for biological methods of making germs fight one another and our aim should be to enhance man’s immune system, as advised in Ayurveda.