Antibiotics must be slowed down to save lives

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Antibiotics must be slowed down to save lives

India among most vulnerable to RAM antibiotic deaths

Access to hospitals and healthcare may be scarce in India, but it still leads to AMR-related deaths (Photo MIG)

The overuse of powerful antibiotics is becoming a deadly new disease across the world and, surprisingly enough, it is the poorer countries that are far more prone to such deaths than the wealthy world. , although access to medicines and health care remains a distant dream for many. .

An alarming report published earlier this year in The Lancet, a medical journal, said antimicrobial resistance was directly responsible for 1.27 million deaths and linked to approximately 4.95 million other deaths worldwide in 2019. Antimicrobial resistance occurs when bacteria causing serious diseases, for example tuberculosis, become resistant to the drugs used to treat the disease. Bacteria become resistant if a particular drug is overused in a particular community, which often forces doctors to prescribe even stronger combinations of drugs and ultimately all of them prove ineffective. Most deaths were caused by drug resistance in lower respiratory tract infections such as pneumonia, followed by blood infections and intra-abdominal infections.

Conventional wisdom would have it that rich countries, with their modern medicines, their wide availability and their financial capacity, would be the main victims of this resistance. Surprisingly, however, cases of antimicrobial resistance have been found most often in two of the world’s poorest regions: sub-Saharan Africa and South Asia. One in five deaths in these regions is in children under five.

This is partly due to the fact that in these two regions, relatively inexpensive generic drugs are easily and widely available, without any prescription and without any supervision. This misuse combined with the lack of clean water and sanitation as well as infection prevention and control leads to the spread of microbes, some of which are resistant to antimicrobial treatment.

The spread of RAM, as the phenomenon is called, is so rapid that experts today believe they have grossly underestimated the dangers it poses. Initial predictions predicted that AMR would cause 10 million deaths by 2050. But now scientists believe that tragic milestone would be reached much faster, possibly even within this decade. It is therefore not surprising that the WHO has declared antimicrobial resistance as one of the 10 most important threats to public health in the world and that the uncontrolled spread of antimicrobial resistances observed so far would seriously compromise United Nations Sustainable Development Goal for development and health for all by 2030.

Bad regulation, drug manufacturers and doctors

Blame for the widespread misuse of antibiotics can be placed primarily on three fronts: government and regulators, doctors, and drug manufacturers. Governments, especially in developing countries, have been lax to the point of criminality in misregulating drug markets. In most of these countries, even the most potent drugs, which normally have to be prescribed with caution by the most experienced physicians in extremely rare situations, are freely available over the counter from the nearby pharmacy without any prescription needed.

Over the decades, as populations and economies have grown, the number of pharmacies or drugstores has multiplied and with it the availability of medicines. The growth of drug manufacturing industries in some developing countries, especially India, which has become the hub of low-cost and high-quality generic drugs.

Generics representing a fraction of branded drugs with almost the same impact, the sale of generic drugs has exploded not only in poor countries, but increasingly, even rich countries are turning to them to control their health costs by spiral.

To sell their drugs, pharmaceutical companies have long used questionable practices, developing extremely close relationships with doctors, “rewarding” them for prescribing their drugs to the point where the rewards amount to nothing less than bribes. , with fully paid vacations abroad thinly veiled as “conference” trips, fancy gadgets and anything short of money for prescriptions.

Since potent antibiotics are more expensive than others, doctors are often “encouraged” to turn to them even when not needed or at least extend the prescription period far beyond what might be needed. .

But it’s not just doctors, some patients, especially the more affluent, prefer their doctors to prescribe the most potent drug on the market, almost the “magic pill”, regardless of the costs involved. Although doctors may say they didn’t want to but only do it to compel their long time patients but in doing so they violate their Hippocratic oath to take care of the patient and it’s the doctor and not the patient who should know which medicine is best for which type of treatment.

Pandemic effect on AMR-related deaths

If the situation of AMR-related deaths was already alarming in 2019, before the start of the Covid-19 pandemic, it may have become even more serious, even critical in the last two years, due to two factors keys.

First, the global health sector and governments have been overwhelmed by the coronavirus, forcing them to ignore other pre-existing and equally deadly health challenges, leading health activists to sound the alarm over the rise deaths from diseases such as tuberculosis, measles or malaria as well as poor vaccination of infants against diseases such as tetanus or poliomyelitis.

The other equally critical effect of Covid-19 has been that over the past two years doctors around the world have turned to extremely powerful drugs, including corticosteroids, such as dexamethasone, hydrocortisone or prednisone , for serious infections, to fight against the unknown virus, especially in how it quickly spread between organs and led to death within days.

More in a desperate attempt to save lives than anything else, millions of doctors around the world are thought to have used or prescribed these drugs. However, corticosteroids, which are used in other serious illnesses, mainly to fight inflammation of blood vessels and muscles, are already known to have serious side effects in most patients.

Their side effects are worse, even deadly, when patients already have other diseases like diabetes, which is especially prevalent in developing countries, including India and the Middle East. Medical experts have warned against using steroids for patients with diabetes or borderline diabetes as it may lead to other infections including bacterial and fungal causing more problems for patients rather than solving them .

Unfortunately, during the various peaks of the pandemic, these steroids were in high demand, leading to a thriving black market as drug manufacturers could not ramp up production to meet the exponential growth in demand. More often than not, although they were intended to be delivered to patients by trained doctors and therefore mainly used in hospitals or clinics, most sales were recorded in high street shops and often without a prescription or even the prescription being used by dozens of people, desperate to get their hands on anything that could save their loved ones. The prices of these steroids, at least in India during the second killer wave of March-July 2021 soared 100 times the maximum selling price allowed by the government.

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