The Life Saving Miracle of Antimicrobials and the Rising Threat of Antimicrobial Resistance (AMR)

 One fateful evening in the year 323 BC, a man lay dying from a disease that can easily be cured with antibiotics today. All his wealth and all his power could not save Alexander the Great from what was likely typhoid fever.

Humanity has come a long way since then. We now have the upper hand in our war against microbes that cause diseases capable of killing many people at once. We have better understanding of these pathogens, we have improved sanitation and perhaps most importantly, we have antimicrobial drugs.

Most people know the famous story of the discovery of penicillin. Sir Alexander Fleming was growing a bacteria colony on a petri dish. Unknown to him, the dish had been contaminated with penicillium mould which secreted a substance that inhibited bacteria growth. Fleming named this antibacterial substance penicillin and the rest, as they say, is history.

Antimicrobials have quite literally revolutionized modern medicine. A cut, a scrape, stepping on a rusty nail and many other things that used to be fatal are typically no longer so. We can now conduct very invasive procedures and surgeries with a low risk of contamination and then follow up with antibiotics to reduce the risk of death from sepsis.

Millions of immunocompromised individuals, HIV positive individuals, patients receiving chemotherapy and organ transplant recipients who are perpetually on immunosuppressants are able to live relatively normal lives despite their weakened immune systems with support from antimicrobial therapy.

However, we risk losing these privileges of the modern age to antimicrobial resistance. Sometimes people use antimicrobials incorrectly, for example not completing a course of antibiotics or not using the correct drug or the correct dose. This leads to incomplete eradication of the offending agent. The surviving microbes can then adapt, developing mutations that protect them from the drug and creating new drug resistant strains of the same organism.

Many strains of bacteria, viruses and even fungi are now resistant to common antimicrobial agents. This forces us to turn to less common and more expensive medications. A one gram vial of intravenous Meropenem costs about fifteen thousand naira. A person who needs ten doses must pay one hundred and fifty thousand naira. Some people cannot even afford four thousand naira to buy Amoxiclav. As the cost of effective antimicrobial therapy rises, the impact becomes heavier on the poor and the downtrodden. This further widens the healthcare gap between people of different socioeconomic classes.

The more we encounter these resistant strains, the more dangerous every cut, every road traffic accident and every caesarean section will become. Every new infection is more likely to be fatal. This is a large and looming public health threat. According to the World Health Organization, in the year 2019, antimicrobial resistance was directly responsible for an estimated 1.27 million deaths globally and contributed to 4.95 million deaths. Antimicrobial resistance is projected to become the leading cause of death by the year 2050 if preventive measures are not taken.

It is not only about deaths. If an infected leg becomes gangrenous because of antimicrobial resistance, the leg will have to be amputated to save the patient’s life. The individual might survive but will be less able bodied than before. Even after months or years of rehabilitation, the person may never return to the pre disease state. Situations like this affect the productivity of individuals and the productivity of the nation as a whole.

We must take the bull by the horn and address this threat now. The obvious place to start is with the responsible use of antimicrobial drugs. Campaigns, flyers and radio and television messages should be sponsored by the government and by nongovernmental organizations to promote good antimicrobial stewardship. People must be educated on its importance and the dangers of failing to use these drugs responsibly. Everyone should use prescribed drugs exactly as instructed, complete their course of antibiotics and not stop taking the medication simply because they feel better. We should avoid using drugs without adequate prescription and avoid using antibiotics for illnesses like the common cold which are caused by viruses.

We also need more funding for research aimed at developing newer, more effective and affordable antimicrobial agents. According to the World Health Organization, there is declining private investment and a lack of innovation in the development of new antibiotics and this is undermining efforts to combat drug resistant infections.

Bacteriophages, a group of viruses that target and kill bacteria but do not infect human cells, may become one of our greatest allies in the fight against antimicrobial resistance. This is a growing area of research. Bacteriophages are already being used to treat diseases that do not respond to antibiotics. Although promising, much more research is required before bacteriophages can become a standard of care across the globe.

Still, I am hopeful and excited about what the future of antimicrobial therapy holds. I hope humanity develops effective ways to combat antimicrobial resistance. Otherwise, the troubles of the past may return to haunt us once more.

References

1. https://en.wikipedia.org/wiki/Death_of_Alexander_the_Great

2. https://www.who.int/news/item/17-01-2020-lack-of-new-antibiotics-threatens-global-efforts-to-contain-drug-resistant-infections

3. https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance

4. https://www.who.int/europe/news-room/fact-sheets/item/bacteriophages-and-their-use-in-combating-antimicrobial-resistance

by Zaynab Boladale