About few years ago, news broke that doctors in America recorded the first ever last-line drug resistant bacterial infection. A woman with a urinary tract infection had this dangerously resistant strain of bacteria in her urine and instantly set the medical community in that country on red alert. What has now been discovered in America is the superbug of superbugs. It should worry us all, even here in faraway Nigeria. The blame is on the overuse of antibiotics.
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A germ achieves superbug status when it is able to survive the onslaught of commonly used antimicrobials. It means the germ is able to continue replicating and sustain an infection even in the face of standard therapy that worked hitherto.
The danger this poses to health is that when one germ develops adequate immunity against a medication, this gene for resistance can spread quite quickly producing a gargantuan army of resistant germs. This is why there is often more than one effective medication for a disease such that when one option fails, an alternative is available to tackle such an infection. And this has worked seamlessly in the past thus there was no real concern at the time.
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Since Alexander Fleming’s 1928 discovery of the first antibiotic, Penicillin, there has been groundbreaking research in the pharmaceutical sector with a remarkable number of new and better antibiotics available to cure illnesses.
This has not, however, been without its challenges. One of such, and probably the most critical, would be drug resistance. It is a phenomenon that portends great danger to the human race as it infers that the germs are a step ahead of us at every turn. While they constantly mutate into better and stronger forms of themselves, we have not been able to develop equally potent drugs.
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The case in America is particularly worrying because the germ in question was found to be resistant to a drug – Colistin- that was only reintroduced into clinical use as a last resort after resistance to several other common antibiotics was noticed.
To suddenly find a drug resistant to the last line of defence must worry any physician because it means sometime in the future, when all else fails, there will be nowhere to turn. It is also interesting to note that the affected patient had no history of recent travel out of the U.S, meaning that the resistance was entirely home grown.
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A common reason adduced for this growing problem has been over-prescription of antibiotics by medical practitioners. A report by the National Institute of Health and Care Excellence posits that annually, physicians in England prescribe up to 10 million antibiotics unnecessarily. This is quite mind-boggling given the extent of control that exists in the NHS.
Imagine what the numbers will be in a country like Nigeria where antibiotics are available at often dangerous doses on every street corner. You can literally walk into any ‘chemist’ shop and procure even the most sophisticated antimicrobials without a prescription.
Already, there have been reports of resistance to antimalarial drugs like chloroquine in Nigeria. This has contributed to the high mortality and morbidity rates recorded in these climes. Also, the WHO reported in 2012 that resistance to common antiretroviral medication had been recorded and was in fact worsening.
This also explains the poor prognosis that is often associated with HIV infection in Africa. Not only are the drugs expensive and not widely available, they are now not as effective. Worrying! Tuberculosis has also been found to have multi-drug strains and this even necessitated the commissioning of a special treatment centre in 2012 by the Lagos State Government.
There has been talk of a post-antibiotic age by the World Health Organisation where superbugs will be responsible for one in every three deaths by 2050. By killing approximately 10 million people annually, even cancer will envy the body count attributed to these new clan of germs in another three decades.
The problem is huge but surprisingly gets little to no attention. The Nigerian government has an arduous task on its hands in sanitising the drug trade space in the country. It is simply too easy to get access to these medication. Doctors across the country, quack and licensed, are very quick to prescribe antibiotics because they work in a system that encourages mental laziness and lousiness.
This must stop. They must pause and dig a bit deeper before resorting to antibiotics. The bigger problem will lie in the many other channels by which antibiotics are accessed freely.
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A number of well-run pharmacy chains in the metropolis now insist on prescriptions before dispensing controlled medication. This is quite laudable. The issue with our people is that they simply find an alternative less-professional outlet to get these drugs rather than visit a clinic for a proper work-up. That is how we are wired and it will take massive health awareness campaigns to correct this mentality. The consequences of our inactions may be far-reaching in the near future.
America has been a medical tourist destination of choice for Nigerians and they now have this drug-resistance issue on their hands. Given the smallness of the world today, this Colistin-resistant bacteria strain may be closer to us than we think.
The real answer might not be development of newer antibiotics after all, but a rational use of the existing ones at all levels of care.
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