By: Atonu Chakrabortty

Introduction:

Not by a secret weapon or by a superman with inflated muscles, wobbly cloak and a big “S” stamped on his chest in the “War of the Worlds” by H.G. Wells, the Martians were defeated by the true rulers of the Earth, the bacteria, against which the invaders did not have resistances in their gigantic machines. Today, almost 120 years after the publication of that gem of science fiction, many researchers warn that a similar scenario could be repeated, but far from fiction and fantasy, this time the civilization could be the victims in the earth.

In recent years, bacteria have adopted and developed through a high-speed process to improve their ability to withstand the effects of our best weapon against them, antibiotics, chemical substances that have saved the life of millions of human beings and have allowed 20 years to extend the life expectancy of people since the discovery of penicillin in 1928.

Antibiotic Resistance:
Resistance to antibiotics is one of the great threats of modern medicine, according to experts. Antibiotic / Antimicrobial resistance is the ability of microbes to resist the effects of drugs – that is, the germs are not killed, and their growth is not stopped. Although there are few persons who are at greater risk than, none can totally capable of avoiding the danger of antibiotic-resistant infections. Infections with microbes which are resistant to antimicrobials are very hard to treat, requiring costly and sometimes toxic alternatives. Inexorably, bacteria (or the other pathogenic microbes) will find ways of resisting the antibiotics developed by humans, which is why aggressive action is needed now to keep new resistance from developing and to prevent the resistance that already exists from spreading.

How does it happen?
Bacteria which are sensitive to a given antibiotic can become resistant by a mutation in their genes or by the acquisition of resistance genes present in another microorganism. This is a natural process which has been happening for a long time. However, the use of antibiotics – and above all, their indiscriminate use – has accelerated this process.
When antibiotics are used to treat diseases, these drugs not only attack the bacteria that cause the disease but also affect many others in the body that are sensitive to the antibiotics used. This leads to a kind of “selection”, and allows resistant bacteria to proliferate, increasing the risk that the patient will suffer a resistant infection in the future. In turn, resistant bacteria can be transmitted from person to person, through water, from food, which entails a risk not only on an individual level but also on a population level. Abuse of antibiotics in both people and livestock has led to an incessant increase in the number and diversity of bacteria resistant to these drugs.

Global Context:
Antibiotic resistance is expanding to relentlessly extreme levels in entire parts of the world. Novel resistance mechanisms are emerging and extending globally, intimidating our ability to treat common infectious diseases. An emergent list of drug-resistant infections – such as pneumonia, tuberculosis, blood poisoning, gonorrhea, and foodborne diseases – are becoming harder, and sometimes impossible, to treat as antibiotics become less effective.
Where antibiotics can be bought for human or animal use without a prescription, the emergence and spread of resistance are made worse. Equally, in countries without standard treatment strategies, antibiotics are often over-prescribed by health workers and veterinarians and over-used by the public.
Without exigent action, we are heading for a post-antibiotic era, in which common infections and minor injuries can once again kill.
For example, according to the Antimicrobial Resistance Review (AMR), in 2013, globally there were 700,000 deaths attributable to antibiotic resistance. Additionally, by 2050, 10 million deaths are expected attributable to antibiotic resistance. It will be the main cause of death and will overcome cancer. One person will die every three seconds.
Last year, the Pan American Health Organization issued an epidemiological alert to the detection of microorganisms with mechanisms of resistance to an antibiotic known as colistin, both in animals and humans. So, it is high time we took precautions against it.

Scenario in Bangladesh
According to various researches conducted in Bangladesh, there is polypharmacy, high use of antimicrobials, vitamins and injectable in hospitals and very low generic prescribing. Additionally, scarce access to effective antimicrobials, inadequate therapy and though occasional but questionable quality of medicine negatively contributed in the emergence of resistance.
Antimicrobial resistance is a growing threat to the maintenance of contagious diseases both globally as well as locally in Bangladesh. During last seventy years, development of effective antimicrobials had a reduced incidence of life-threatening infections, however, that achievement has been eroded by the emergence of resistance. Microbes developed resistance primarily in the hospitals, however, that later spread in the community imposing more risk to the human health.
Infections with resistant microbes not only result in greater morbidity and mortality but also increase the health care costs. The loss of effectiveness of the antimicrobials leads to longer duration of research as well as increased development expenses.

Prevention and control:
To fight against antibiotic resistance our government along with us can take the measures as follows:
1. Converting the appropriate use of antibiotics in medicine, livestock and agriculture into a priority quality standard
2. Making the Programs of Optimization of Use of Antibiotics (PROA) mandatory as quality care programs based on training in hospitals and primary care, and provide them with the necessary means
3. Providing the necessary resources to the Services / Laboratories of Microbiology for the detection of bacterial resistance, creating rapid diagnostic tests and sensitivity studies
4. Having information in real time of the key indicators in antibiotic consumption, bacterial resistance, and its clinical consequences
5. Promoting multidisciplinary programs of surveillance, prevention, and control of infections related to healthcare along with those of appropriate use of antimicrobials Create the specialty of infectious diseases and maintain the current training of microbiologists
6. Educating citizens, from school to university, in the proper use of antibiotics
7. Promoting the development of new antibiotics, participating in clinical trials and speeding up their incorporation into clinical practice. Investigate available antibiotics to improve their efficacy and safety
8. Investigation of other measures, not antibiotics, for the prevention, control, and treatment of infections by multi resistant bacteria
9. Optimization of the vaccination rates, particularly against influenza, of health professionals and citizens

References:
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European Centre for Disease Prevention and Control (ECDC), European Food Safety Authority (EFSA), European Medicines Agency (EMEA). Joint opinion on antimicrobial resistance (AMR) focused on zoonotic infections. 2009. Available at: http://www.efsa.europa.eu/en/ scdocs/doc/1372.pdf
World Health Organization. WHO list of critically important antimicrobials (CIA), 3rd revision. 2011. Available at: http://www.who.int/ foodsafety/publications/antimicrobials-third/en/
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