THE tendency to pop antibiotic pills at every sneeze has brought us to the brink of a disastrous health crisis. For years, experts worldwide have been pointing to the hazards of anti-microbial resistance — the ability of bacteria and other microbes to adapt to and develop defence mechanisms against liberally dispensed antibiotics.
The WHO estimates that AMR could result in 10m deaths a year by 2050. The most affected region is South Asia, with AMR levels in Pakistan being just short of catastrophic. In March, the chairman of the drug regulatory authority warned that if antibiotic misuse wasn’t stopped, a ‘superbug’ could emerge.
Though the AMR crisis has long been in the making, in Pakistan it was the 2016 outbreak of extensively drug-resistant typhoid in Hyderabad, subsequently exported to at least seven countries, that raised alarm bells. The strain proved resistant to ceftriaxone, used to treat multiple-drug-resistant typhoid.
Cases were brought under control only when the Sindh government introduced a vaccine for XDR typhoid for all children in the province. However, the vaccine is not a solution: XDR typhoid is one mutation away from becoming untreatable — and deadly. Cases of tuberculosis and malaria resistant to drugs are also on the rise.
A local study puts the annual number of MDR TB cases in the country at around 14,000. Half of these cases demonstrate resistance to second- and third-generation antibiotics. There are many other examples of increasing microbial resistance. A recent study involving 2,000 patients at Karachi’s Civil Hospital found 95pc of bacterial infections to be resistant to several antibiotics. The main reason behind this scourge is the overuse and misuse of antibiotics — in humans and animals — making bacteria increasingly resistant to the medicines manufactured to kill them.
WHO has warned that the Covid-19 pandemic would lead to even higher AMR levels due to increased antibiotic use. To elaborate, consider the broad-spectrum antibiotic azithromycin which proved effective in many secondary Covid infections. Though Covid-19 cases have dropped, azithromycin has become the go-to antibiotic being used to treat even the seasonal flu caused not by bacteria but a virus.
In the wake of World Antimicrobial Awareness Week observed this month, it is opportune to remind the government to implement its AMR National Action Plan of 2017, enacted in line with the WHO’s One Health policy that is based on the idea of the consanguinity of humans, animals and the environment and how the health of each group is dependent on the other — as demonstrated by the XDR typhoid outbreak that was concentrated in an area where sewage water had contaminated the drinking water supply.
Equally important, the government should regulate the unchecked sale of antibiotics by pharmacies and fine retailers who sell antibiotics without a prescription. Measures on a war-footing are needed if the government wants to avert a health catastrophe potentially worse than the pandemic.
Published in Dawn, November 28th, 2021