A popular saying in the Tamil language goes as “Alavirku minjinal amuthamum nanju” which means, that something as loveable as nectar will turn out to be poisonous when taken in excess. The fate of antibiotics has become so. The once hailed hero is now feared for causing chaos and morbidity due to excessive use. The spread of multidrug-resistant organisms has drastically increased within the past fifty years. Following the introduction of penicillin in the 1930s, approximately 50% of Staphylococcus aureus strains were resistant to penicillin 10 years later, in the UK alone. In 1959, methicillin was introduced to treat penicillin-resistant S. aureus, which resulted in the emergence of multidrug-resistant S. aureus in less than three years¹. As of 2019, more than two million people in the United States become ill with antibiotic-resistant diseases each year. The estimated mortality rate due to antimicrobial-resistant infections by the year 2050 is 10 million. Hence, we’ve an urgent call to act now and fast by strategizing ways to minimise and prevent its proliferation².

What can I do to combat antibiotic resistance as an individual?

Fighting antibiotic resistance requires a collaborative effort between doctors, scientists and patients. Since antibiotic resistance is a natural phenomenon, it cannot be completely eradicated. However, CDC has implemented some strategies that help to decelerate the spread of resistant bacteria and control its impact on society³.  

1. Get vaccinated 

Vaccination has a substantial impact on controlling antibiotic resistance. For example, since the introduction of the pneumococcal injection, infections, antibiotic prescriptions and circulation of resistant strains decreased. In the case of smallpox, the disease was completely eradicated due to vaccination. Unfortunately, the majority of the prominent antibiotic-resistant infections lack vaccines⁴. Nevertheless, the emergence of novel antibiotic infections can be stopped when we follow the currently available vaccination schedules. 

2. Use catheters responsibly

Urinary catheters are used by about 15 to 25% of hospitalised patients to manage urinary drainage post-surgery or by those with mobility difficulties⁵. Prolonged catheterization for over 30 days, results in the formation of biofilms that are predominantly antibiotic-resistant. Hence, it is important that catheters are used only when absolutely required and should be removed immediately when no longer required⁶.

3. Use drugs rationally and correctly 

As we learned in the previous segment of this series, each antibiotic has unique pharmacokinetics to suit a group of bacteria. Prescribing broad spectrum drugs during the first visit increases the risk of the development of antibiotic-resistant strains. Physicians should get into the habit of taking culture samples from patients and formulate a therapy to likely or known pathogens. Also, the purchase of antibiotics over the counter should be prohibited. Furthermore, many fail to complete the required course of antibiotics due to symptoms diminishing. This leaves room for a residue of pathogens to persist on. The remaining few pathogens are able to eventually adapt to the stressful condition created by the drugs and immunological components through the acquisition of resistant mechanisms. This gives rise to new strains of bacteria that are able to escape our immune system. Hence, the prescribed medication should be followed religiously independent of the improvement in symptoms experienced³.  

4. Reduce antibiotic treatment 

Antibiotics as first aid for sore throats and stomach side effects has become the norm. Several other home remedies are available for simple infections. For example, honey is an effective medication for sore throats and consumption of mint is able to relieve stomach ailments. Furthermore, many underestimate the potential of staying hydrated while sick. Most importantly, break the cycle of infection by staying home when you are sick and following basic hygiene practices such as washing hands thoroughly after visiting a public place.  

5. Consult the experts

General physicians often disregard the importance of consulting specialists for patients who exhibit symptoms of infection. Studies show that disease consultation from infectious diseases specialists leads to improvements in clinical management by way of reducing rates of recurrent disease, mortality and cost⁷.

Modern medicine has been the cornerstone for saving over billions of lives but its misuse is unnecessarily costing the lives of many more. Before you pop a pill, remember the acronym CAM which stands for Correct – Ask – Minimise. Am I following the correct dosage? Have I asked an expert? Can I minimise or abstain from the use? When each of us do our part, we stop novel infections from rising and prevent the spread of current infections. 

Author: Esther Swamidason

References

1. Friedman, N. D., Temkin, E., & Carmeli, Y. (2016). The negative impact of antibiotic resistance. Clinical Microbiology and Infection, 22(5), 416–422. https://doi.org/10.1016/j.cmi.2015.12.002
2. Dadgostar, P. (2019). Antimicrobial Resistance: Implications and Costs. Infection and Drug Resistance, Volume 12, 3903–3910. https://doi.org/10.2147/idr.s234610
3. ‌CDC Media Relations: Press Release. (2022). Retrieved March 8, 2022, from https://www.cdc.gov/media/pressrel/r020326.htm
4. Micoli, F., Bagnoli, F., Rappuoli, R., & Serruto, D. (2021). The role of vaccines in combatting antimicrobial resistance. Nature Reviews Microbiology, 19(5), 287–302. https://doi.org/10.1038/s41579-020-00506-3
5. Al-Qahtani, M., Safan, A., Jassim, G., & Abadla, S. (2019). Efficacy of anti-microbial catheters in preventing catheter associated urinary tract infections in hospitalized patients: A review on recent updates. Journal of Infection and Public Health, 12(6), 760–766. https://doi.org/10.1016/j.jiph.2019.09.009

6. Köves, B., Magyar, A., & Tenke, P. (2017). Spectrum and antibiotic resistance of catheter-associated urinary tract infections. GMS Infectious Diseases, 5, Doc06. https://doi.org/10.3205/id000032

7. Saunderson, R. B., Gouliouris, T., Nickerson, E. K., Cartwright, E. J. P., Kidney, A., Aliyu, S. H., … Török, M. E. (2015). Impact of routine bedside infectious disease consultation on clinical management and outcome of Staphylococcus aureus bacteraemia in adults. Clinical Microbiology and Infection, 21(8), 779–785. https://doi.org/10.1016/j.cmi.2015.05.026

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