As antimicrobial resistance threatens to turn even a mild scratch into a life threatening illness, everyone can do their bit to stave off the problem
Global thought leaders have come up with a series of steps that, if implemented jointly by people and nations, can drastically reduce antimicrobial resistance (AMR). Here is a previous report on the causes and spread of AMR in the world.
There is a five-point plan that world leaders are now taking seriously. And as a citizen here is what you can do to safeguard your personal health.
“Hand hygiene is the single most effective way to prevent infections,” says Dr V Ramasubramanian, Senior Consultant, Department of Infectious Diseases, Apollo Hospital who is also in an advisory capacity with the Antimicrobial Stewardship Initiative, a program set up by Indian Council for Medical Research (ICMR). “Infections spread through bacteria present on the hand. So clean hands means that infections do not spread so easily and antibiotics need not be taken so often. This in turn reduces antimicrobial resistance,” he adds.
“Antibiotics are not wonder drugs,” continues Dr Ramasubramanian. “A common cold or a flu cannot be cured using antibiotics since it is caused by a virus. Overuse of antibiotics will speed up the resistance of the bacteria to the drug. So please stop demanding antibiotics from your doctor,” he says.
“Many people consume the same antibiotics by themselves, without consulting a doctor, if an infection reappears,” he says. “Do not use leftover antibiotics for the next time. Use antibiotics only with your doctor’s advice,” says the doctor.
“With the era of Google, patients are increasingly gaining some knowledge online and self-medicating,” says Dr Ramasubramanian. “Remember, Google is not a replacement for your doctor. Do not consume antibiotics if some article on Google recommends them for an ailment,” he says.
“As antibiotics become resistant to more classes of drugs, it is time to ensure that our own immunity becomes stronger and is able to fight off the bacteria on its own. Vaccines are the best way to boost our immune system, with minimal side effects. We give vaccines to children but adults too need to take vaccines – today there are vaccines for flu (it includes a swine flu strain in it) and even cervical cancer. Even if the vaccine’s success rate is only 70%, I would say it is worth it,” says Dr Ramasubramanian.
Prevent, Not Cure
At the government level, a number of changes will have to take place in order to clamp down on the spread of AMR and related deaths, before the healthcare system collapses under its weight.
The first is to allocate funds for a full fledged awareness campaign to tell people what AMR means and how they can help in curbing this.
“Studies have shown that public awareness or behaviour change campaigns can be very cost-effective and lead to lasting changes, when run well. One study showed that in Belgium, campaigns to reduce antibiotic use during the winter flu season, resulted in a 36 per cent reduction in prescriptions. Over 16 years, the cumulative savings in drug costs alone amounted to around 130 Euros (150 USD) per Euro spent on the campaign,” according to the Jim O’Neill report commissioned by the British government in 2016.
Another way to stem the overuse of antibiotics is to bring in legislation that regulates over-the-counter (OTC) sale of antibiotics. Pharmacists insisting on a prescription from a doctor could well reduce the abuse of antibiotics. This, though, is debatable when it comes to the poorer nations where doctors, especially in rural and remote areas are hard to come by and pharmacists often double up as doctors.
The onus, basically, is on preventing infections rather than attempting to cure, as far as possible.
This would also mean that governments need to clean up their act, literally. Sanitation and hygiene, clean drinking water, ensuring that sewage and drinking water lines do not mix and handling trash in an eco-friendly and sustainable manner are all key to this.
The Jim O’Neill report cites how infections can be drastically reduced when surrounds are clean. “The volume of antibiotic consumption associated with preventable diarrhoeal illness is therefore substantial: modelling commissioned by the Review suggested that across four middle-income countries (India, Indonesia, Nigeria and Brazil), close to 500 million courses of antibiotics are each year used to treat diarrhoea. With universal access to improved water and sanitation, though, this would be reduced by some 60 per cent.”
The report also speaks about how average life expectancy of the population of a country can be increased by 9.5 years if access to sanitation is increased by just 50%.
Cutting off effluents containing antibiotics from entering into sewage supplies and seeping into the ground is also a necessary step to take by nations. “One study found 45 kg of ciprofloxacin (an antibiotic commonly used to treat bladder and sinus infections) – the equivalent of 45,000 doses – leaking daily from factories into a nearby river. Environmental contamination like this has led to an antibiotic-resistant bacteria being detected as far afield as Antarctica,” cites the Jim O’Neill report.
Dr Ramasubramanian says that prevention begins with all of us.
“Personal hygiene, stopping open defecation, not spitting on the ground, open urination, all of these habits can be stopped easily,” he says. “This will prevent the spread of infections to others. Legal and policy level intervention is also the need of the hour to regulate the use of antibiotics in the food industry – cattle, poultry and fish. And unless we do all of this together now, India will find it very very difficult to deal with the burden of AMR on its public and private healthcare system,” he says.