Indian doctors were galvanized last month when the prestigious medical journal, Lancet, published an article describing super bugs that are virtually resistant to all known anti-biotics, and alleging that they originated from the Indian subcontinent. To add insult to injury, the lead authors, who were British, named this germ after New Delhi (NDM1), consigning the name of our national capital to the immortal pages of medical notoriety.What most Indians found blasphemous was the fact that although this highly resistant strain was also isolated from other parts of the world, the authors chose to name it after New Delhi, a city from which no sample had actually been tested, and went on to sound a travel advisory cautioning Britishers to travel to India for “medical tourism”.
Development of resistance in bacteria to the latest and strongest antibiotics called Carbepenems, is however alarming news. Alexander Fleming, who had discoverd the first antibiotic, penicillin, in 1941, would have been a very sad man if alive today. While scientists have discovered numerous antibiotics ( I could count 120) over the last 7 decades, germs have discovered ingenuous ways of escaping them with equal promptness.
When Carbapenems (Meropenem and Imipenem) were launched around a decade back, we had thought that the fight against germs was finally over. The last 3 years have shown that despite using high doses of expensive antibiots (they cost around 2 to10, 000 per day!) bacteria are able to survive, multiply and attack, accounting for a growing number of deaths from sepsis.
It is however difficult to deny that antibiotic resistance is common in India. Take the example of the most frequently used ones called quinolones (ciprofloxacin, norfloxacin, ofloxacin etc) that we pop so easily when we have fever, loose stools or any symptom remotely suggestive of an infection. With easy availability, low price, favourable safety profile and widespread use most bugs are now resistant to this group of drugs. Consequently, when treating a serious infection like typhoid fever, one remains worried whether thiese drugs will work or whether we should add another for safety.
Resistance increases with more usage, inadequate doses that allow some germs to remain and fight back, and easy over-the-counter (OTC) availability, as often happens in India. Resistance, once developed, often gets passed from one bug to another through a portion of DNA called plasmids.
Another common cause is the indiscriminate or excess use of antibiotics in veterinary practice and in growing live stock. Drugs are used in animals that are used as human food, such as cows, pigs, chickens, fish, etc., and these drugs can affect the safety of the meat, milk, and eggs produced from those animals and can be the source of superbugs The chemicals pass into our bodies and evoke resistance in the germs that dwell in our skin or gut.
While scientists continue their search for newer more lethal antibiotics, with the emergence of super bugs, the fight seems far from over and speculation remains rife as to who will have the last laugh - the injudicious man or the ingenous bug.
As published in HT City ( Hindustan Times) dated 10 october, 2010.
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