HUMANKIND is on the cusp of losing the battle against one of its most primaeval foes: bacteria. We are at a juncture where antibiotics, one of the most potent tools with which to fight these pathogens, have become nearly — in some cases, completely — ineffective against them. What seems certain to follow is described as no less than an apocalypse, a ‘post-antibiotic world’ where even a minor cut or routine surgical procedure will be a high-stakes gamble with death. Antibiotic resistance could kill 10m people per year by 2050. Pakistan’s alarming situation in this unfolding nightmare was put into context on Saturday by Dr Nizam Damani, a consultant with WHO’s Global Infection Prevention and Control Unit in Switzerland during a medical conference in Karachi. Citing preliminary results of an ongoing study, the infectious disease specialist said that out of 2,000 patients at the city’s Civil Hospital, 95pc had tested positive for bacteria that was resistant to a wide range of antibiotics. These findings are cause for action on a war footing. The already dire health indicators in Pakistan and the shambolic state of public health infrastructure here amplify the risk immeasurably.

The tendency to overprescribe antibiotics as though they are a cure-all for all kinds of illness — the drug is completely ineffective against viral infections — is the primary reason the world is confronted with this scenario. In developing countries like Pakistan, where antibiotics can be obtained across the counter and lack of awareness means they are perceived as a silver bullet for infections across the board, their abuse is very widespread. Antimicrobial resistance is a Darwinian struggle in which pathogens evolve and acquire genes that strengthen their defences against drugs that target them. The process has been taking place ever since sulphonamides, the first antibiotics to be used systematically, were introduced in the late 1930s. But it accelerated dramatically through overuse of antimicrobials in the last few decades. The result is a slew of bacteria that are either multidrug-resistant or even pan-resistant. Multidrug-resistant tuberculosis is making itself felt in Pakistan, a nightmarish prospect if it is allowed to get out of control. Regulatory authorities should waste no time in taking measures to address the issue. They should clamp down on the easy availability of antibiotics, advise medical professionals to prescribe them judiciously and educate the public about the catastrophic consequences of taking antibiotics unthinkingly.

Published in Dawn November 15th, 2016