The global pipeline producing new antibiotics has dried up. Drug resistance is on the rise and we are not left with many combating options. The first antibiotic, Penicillin, was discovered in 1928 setting in motion the magical antibiotic era during which miraculous life-saving cures became the norm, owing to the golden bullets which antibiotics are in terms of their specificity towards killing the intended bacteria. More than 100 such compounds have been found ever since, but no new class of antibiotics has been discovered after 1987.
The immense success of antibiotics has plunged us into an era of misuse. We have used these drugs at harmful doses and even for viral infections such as common cold or flu, where they serve no purpose at all. The easy availability of antibiotics over-the-counter and the socially embedded trait of self-medication have further compounded the issue.
Furthermore, little or no attention has been paid to the farming industry. Mass usage of antibiotics by farmers to prevent infections and to speed up the growth of livestock has transformed farm animals into disease-spreading machines. These animals harbour antibiotic-resistant bacteria till they reach our dining tables. This together with the lack of new antibiotics and unmatched survival skills of microbes has allowed these primitive organisms to hold their ground by developing different resistant strains.
The typhoid superbug is resistant to five types of antibiotics and only azithromycin, the last line of defence, has the capability to kill it. Another genetic mutation in this superbug would render it untreatable
The latest is drug-resistant typhoid fever, first known epidemic of its type, which began in November 2016 from Hyderabad and has since spread across Pakistan attacking at least 850 people. The typhoid superbug is resistant to five types of antibiotics and only azithromycin, the last line of defence, has the capability to kill it. Another genetic mutation in this superbug would render it untreatable. This has raised worldwide fears that more resistant infections might be on their way.
The solid waste materials of a typhoid patient contain the causative bacteria. Typhoid fever is spread by the ingestion of food or water contaminated with these stools. Now, how do infected human wastes come in contact with what we eat or drink? The answer lies in our abysmal sewage and water regulation system, the root cause of this epidemic. Sewage lines throughout Pakistan are either non-existent or broken which allows bacteria to contaminate nearby potable water and food sources. This is how typhoid takes its deadly leap.
The symptoms of typhoid are non-specific and may overlap other infectious diseases which make it a tricky disease to diagnose. Third-generation antibiotics like cefixime and ceftriaxone are the drugs of choice for typhoid. Unfortunately, we have used these miracle drugs like oxygen, which has made them ineffective. Paracelsus, a 16th century Swiss physician, pointed this out early on, ‘All things are poison and nothing is without poison; only the dose makes a thing not a poison.’ Even if food or water is taken in quantities greater than what is required by the body, it can lead to perilous outcomes.
The magnitude of the global crisis, which antibiotic resistance is, was reported in 2014 by WHO in words, ‘this serious threat is no longer a prediction for the future, it is happening right now in every region of the world and has the potential to affect anyone, of any age, in any country.’ Four years down, we are in much deeper waters than before.
Today we stand at the threshold of the post-antibiotic era, where conditions such as a minor skin cut could lead to death. The decades of triumph against the microscopic world might come to an end unless drastic measures are taken. To defeat the resistant typhoid bacteria, sanitary environmental reforms and maintaining adequate levels of hygiene are the only solutions. Our people are paying heavily as diseases are spreading fast in our poorly sanitized communities. It is high time to provide basic facilities to the citizens or we would go down in history as the country which breeds multi-drug resistant infections.
The writer is a full-time medical doctor and a part-time freelance writer based in Islamabad. He tweets @rajakhalidshab
Published in Daily Times, May 24th 2018.