The experts warn

'Antimicrobial resistance: Global report on surveillance' by WHO: "A post-antibiotic era—in which common infections and minor injuries can kill—far from being an apocalyptic fantasy, is instead a very real possibility for the 21st century."

Dr. Abdul Ghafur K: When we are called to manage patients with severe infections due to pan resistant bugs, we do really wonder whether we are living in pre-Alexander Fleming years without antibiotics and then with a shock, but no surprise, realise that we have reached the end of antibiotic era. Still, the Indian medical community remains in a state of denial. We have not yet taken the issue of antibiotic resistance seriously. We believe that Dr. Fleming has discovered penicillin only early this morning and consider antibiotic resistance a problem of next century where in fact antibiotics are dead and the foul smell of decay is already around us. You may call me a pessimist, but I sincerely believe that it is too late to save antibiotics; unless you have divine powers to bring the dead back to the life.

Cesar A. Arias and Barbara E. Murray: It is more difficult than ever to eradicate infections caused by antibiotic-resistant “superbugs,” and the problem is exacerbated by a dry pipeline for new antimicrobials with bactericidal activity against gram-negative bacteria and enterococci. A concerted effort on the part of academic researchers and their institutions, industry, and government is crucial if humans are to maintain the upper hand in this battle against bacteria — a fight with global consequences.

Tuesday, December 23, 2014

Losing the war: How Kathmandu can give rise to dreadful superbugs

 Brian Beard
(First published on The Kathmandu Post on 14th December.)
DEC 13 - An invisible war is going on all around between bacteria and antibiotics, and bacteria are starting to win. Bacteria are tiny living organisms that are in every place you can imagine—on your skin, in your food, in the air, and in the water. Antibiotics are substances that kill bacteria and are produced by other bacteria or certain types of fungus. Dr Alexander Fleming uncovered this invisible war almost 90 years ago and from his work came one of the most important scientific discoveries in history—the first antibiotic, penicillin.
Since the discovery of penicillin, many more antibiotics have been found. The use of antibiotics to treat patients with bacterial infections, which are illnesses caused by disease-causing bacteria, have changed modern medicine. No doubt, some people reading this article are alive today because antibiotics saved them from a life-threatening bacterial infection. It seemed as if sickness and death from bacterial infections were a thing of the past, or were they? Ever so quietly, bacteria have started to fight back, and now after a decades-long battle ‘stronger’ bacteria are launching a deadly counterattack.
Fighting back
Doctors began to notice that sometimes antibiotics did not work, and what were formerly easily treatable bacterial infections were killing patients. As some scientists had long suspected, bacteria had developed the ability to defend themselves against antibiotics and this ability could be passed onto other bacteria. These types of bacteria are now known as multi-antibiotic-resistant bacteria, also commonly called ‘superbugs’.

Superbugs have quietly killed millions of people and have become a worldwide epidemic. More and more people are coming to hospitals with superbug infections that cannot be easily treated with antibiotics. This is particularly dangerous for infants and children, the elderly, and people who are already sick. For these patients, a superbug infection can kill them. This begs the question, where did these superbugs come from?
The major issues that have contributed to the emergence and spread of superbugs have been—using antibiotics so frequently that it has become as routine as morning tea; living in overpopulated areas where it is impossible to avoid contact with sick people; and inadequate access to clean drinking water. Do these situations sound familiar? They should, because the Kathmandu Valley is a dangerous combination of all three situations, which means a superbug attack could be incoming.
An unholy confluence
First, look around at all the street-side pharmacies where it is quite easy to purchase antibiotics. Second, the population boom in Kathmandu continues unchecked. Third, recent data from the United States Agency for International Development (USAID) found that one in every four people in the Kathmandu Valley does not have access to clean drinking water, and the single largest water source, the Bagmati River, continues to have untreated sewage filled with superbugs dumped into it on a daily basis. All of these factors coming together in the Kathmandu Valley are a recipe for disaster, and to make matters worse, it is becoming clear that there are toxic elements in the environment that select for even ‘stronger’ superbugs.
One of the most toxic elements, arsenic, occurs naturally in the earth’s soil and is often found in water supplies that provide drinking water. Long-term exposure to arsenic in drinking water carries its own risk of arsenic poisoning, arsenicosis, but there is a new concern with regard to superbugs. Arsenic is toxic to bacteria and in order to survive, some superbugs in arsenic-contaminated water have developed a defence against arsenic that is very similar and linked to the antibiotic defence system. Because the arsenic and antibiotic defence systems are linked, superbugs only need to be exposed to either arsenic or antibiotics to select for new even ‘stronger’ superbugs. The concern is that high levels of arsenic in drinking water supplies contaminated with superbugs, often from untreated sewage, will act as a perfect selection environment for dangerously stronger superbugs.
A contaminated drinking water supply can expose large portions of the population to new superbugs, leading to widespread infections that are extremely difficult if not impossible to treat. Arsenic contamination of water supplies is very real for Nepal, because numerous studies have shown high levels of arsenic in surface and well water sources in the Tarai region and the Kathmandu Valley. The levels of arsenic frequently exceed what is considered safe by the World Health Organization (WHO) of 10 parts per billion (ppb) and often exceed the Nepal Interim Arsenic Guideline of 50 ppb. Even if you only consider the Tarai region, it is estimated that from drinking water over 1,000,000 people are exposed to arsenic levels above the WHO standard and 300,000 people are exposed to arsenic levels above the Nepal standard. Elements in the environment, like arsenic in drinking water that can select for dangerous superbugs, present a new challenge that people need to realise and understand.
The battle against ever-stronger superbugs rages on with no end in sight. The continued emergence and spread of superbug infections, often through contaminated drinking water, was highlighted by a frightening report on the global threat of antibiotic-resistant bacteria (superbugs) released this year by WHO that warned of a looming post-antibiotic era where easily treatable bacterial infections will once again turn deadly.
Some protection
These are serious problems, but there are everyday steps you can take to minimise the risk to yourself, your family, and the larger Nepali community. To start, only take antibiotics prescribed by a medical professional and dispose of extra antibiotics properly by returning unused doses to a health care facility. If you rely on a drinking water supply that you suspect might be unsafe, the Nepal government has partnered with numerous national and international non-government organisations to conduct an Arsenic Mitigation Programme. This programme monitors arsenic levels in water and in areas with particularly high levels of arsenic, the programme has begun to help provide inexpensive filters, such as the Kanchan Arsenic Filters (KAF), which can remove both arsenic and bacteria contamination from water. As a long-term goal, you can pressure elected officials to provide clean drinking water for everyone with nationwide water purification, and just as important, address the dismal sanitation infrastructure. Your individual health is linked to the community around, so it is important for everyone to understand and act responsibly to protect yourself, your family, and your community.
Beard is a research scientist interested in the interaction between environmental arsenic and disease-causing bacteria, and holds a PhD in Biochemistry
First Posted on: 2014-12-14 09:39 on 
Courtersy: Ekantipur website. Posted here in public interest for purely non-commercial purpose. 

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