Human intelligence is capable of working wonders.One of these wonders was the discovery of antimicrobial drugs, the prototype of which was Penicillin, unearthed by relentless efforts of Scottish biologist Alexander Fleming in1927. This discovery revolutionized the field of medicine as the discovery of gunpowder had revolutionized warfare in the preceding centuries.
The 1950s are remembered as the golden era of antimicrobials. For, in this period of time a record number of breakthroughs were achieved by the medical community. Fatal diseases like pneumonia, diarrhea, malaria, which were veritably untreatable in the past, became amenable to the antimicrobials.Thus, the scourge of microbial disease was being swept away, much to the relief of humanity.
Besides the cure offered by the antimicrobial drugs for the deadly infections, which was its primary use, myriad secondary benefits were also derived from these magic bullets.These included protection from infection in patients, undergoing complex surgical procedures, appendectomy, hip replacement surgeries, organ transplants etc.
On the other hand, leeway furnished for the treatment of cancer, where the dilemma faced by physicians, was the patient undergoing treatment becomes increasingly vulnerable to microbial infections – probably life-threatening owing to a feeble immune system as a direct result of anti-cancer therapy.
So, in a nutshell, the antimicrobials singlehandedly transformed the arena of healthcare, thus becoming in the process a mainstay of modern medicine as we know it.
The havoc wreaked by the pestilence, epidemics had become a thing of the past. The ingenuity of microbes i.e. bacteria, virus, fungi was not lost upon Alexander Fleming, for he presciently declared that if this resource is not used carefully then a day might come when this boon shall be the bane of mankind.
His prophetic words have indeed become true, for according to the numbers compiled by a British panel in the Review on Antimicrobial Resistance approximately 700,000 people die each year due to infections caused by drug resistant microbes.The figure they claim can be very high since there is no mechanism for surveillance and collection of data regarding the death toll attributed to drug resistant microbial specie in middle and low income countries.
The review does not stop here, and as per their projections if this problem is not tackled then by 2050, this menace would claim the lives of a whopping 10 million people a year, becoming in the process most ruthless killer of mankind, second to none,with the economic costsperhaps running into trillions of US dollars.
How we reached this crossroads which leads to perdition of us all, is by virtue of misuse/overuse of available agents in humans.
A survey conducted in USA came up with this startling revelation where 50% of antibiotic prescriptions issued were termed unnecessary:self-administration by patients of antibiotics without advise from physician due to lack of resources and/or absence of drug laws or their lax implementation by authorities.
The arbitrary use in animal husbandry and agriculture, not as a curative agent, but as growth promoters, is another major facet of this manmade disaster.The consumption by humans of these antibiotic fed fowl is a source of transfer of resistant specie of microbes.
The inability to create new drugs – the stream of which has completely dried, for we haven’t seen a truly new class of Antibiotics in the last 2-3 decades, leading to market failure where the hindrance of new supplies – has resulted in current crop of drugs run obsolete owing to the emergence of resistant strains of formerly susceptible microbes.
Now this monster runs amok threatening to crush under its feet the hard won gains of the last century.
The beast, if not tamed, would spawn a breed of microbes called “superbugs” which are tolerant to all the available antimicrobial agents and will usher in the “Post-Antibiotic Era” – where the once easily curable infections like malaria, pneumonia, typhoid would again kill its victims – where the virtually de-risked surgical procedures on which life of millions depend would become too dangerous to perform – where the risks for anti-cancer therapy, which saps the immune system, of its vitality would be reinforced.
Alert to this crisis, the May 2015 World Health Assembly adopted a global action plan on antimicrobial resistance which outlines five objectives:
- To improve awareness and understanding of antimicrobial resistance through effective communication, education and training.
- To strengthen the knowledge and evidence base through surveillance and research.
- To reduce the incidence of infection through effective sanitation, hygiene and infection prevention measures.
- To optimize the use of antimicrobial medicines in human and animal health.
- To develop the economic case for sustainable investment that takes account of the needs of all countries and to increase investment in new medicines, diagnostic tools, vaccines and other interventions.