AN­TIBI­OTIC APOCA­LYPSE

Jamaica Gleaner - - IN FOCUS -

IHAVE never ad­vo­cated that peo­ple who rou­tinely feed low doses of an­tibi­otics to live­stock should be ex­e­cuted with­out trial. That would be too harsh, too ir­rev­o­ca­ble. There should be fair tri­als, and fines for a first of­fence, and prison for a sec­ond. Only ha­bit­ual of­fend­ers should face the death penalty.

But first, there has to be a law. At the mo­ment, it isn’t even il­le­gal in most coun­tries.

At the United Na­tions re­cently, ev­ery sin­gle mem­ber coun­try signed a dec­la­ra­tion that recog­nises the rise in an­tibi­otic re­sis­tance as a threat to the en­tire en­ter­prise of mod­ern medicine. It’s a start, but that’s all it is — and time is run­ning out.

“The emer­gence of bac­te­rial re­sis­tance is out­pac­ing the world’s ca­pac­ity for an­tibi­otic dis­cov­ery,” World Health Or­gan­i­sa­tion Direc­tor Gen­eral Mar­garet Chan warned the meet­ing. “With few re­place­ment prod­ucts in the pipe­line, the world is head­ing to­wards a post-an­tibi­otic era in which com­mon in­fec­tions will once again kill.”

The dec­la­ra­tion urges coun­tries to cut back on the use of ex­ist­ing an­tibi­otics in or­der to pre­serve their ef­fec­tive­ness, to make bet­ter use of vac­cines in­stead, and to spend more money on de­vel­op­ing new an­tibi­otics. It doesn’t put any ac­tual money on the ta­ble, how­ever, and it doesn’t even make make it il­le­gal to pump ‘sub-ther­a­peu­tic’ doses of an­tibi­otics into farm an­i­mals. (It can’t. Na­tional gov­ern­ments have to do that.)

I was not re­ally rec­om­mend­ing the death penalty for feed­ing an­tibi­otics to live­stock. That was just for dra­matic ef­fect. But the reck­less mis­use of an­tibi­otics is rapidly de­stroy­ing their ef­fec­tive­ness.

A re­cent study by Pub­lic Health Eng­land found that the pro­por­tion of campy­lobac­ter bac­te­ria that are re­sis­tant to ciproflaxin, the standard an­tibi­otic in cases of food poisoning, has risen from 30 per cent to 48 per cent in just the past 10 years. If we don’t stop the rot, we are head­ing back to the 19th cen­tury in terms of our abil­ity to con­trol in­fec­tions. Even mi­nor wounds and sim­ple op­er­a­tions will carry the risk of death.

The same goes for com­mu­ni­ca­ble dis­eases. In the 19th cen­tury, tu­ber­cu­lo­sis was the big­gest killer of young and mid­dle-age adults in Europe and Amer­ica. With the dis­cov­ery of strep­to­mycin in 1944, iso­ni­azid in 1952, and ri­famptin in the 1970s, it ceased to be a ma­jor health prob­lem. But now, the drug re­sis­tance has grown so great that at least 190,000 peo­ple world­wide died of tu­ber­cu­lo­sis last year.

The prob­lem of bac­te­rial re­sis­tance has been un­der­stood for a long time. If the an­tibi­otic kills all the harm­ful bac­te­ria it tar­gets in the per­son or an­i­mal it is given to, no re­sis­tance de­vel­ops. But if it only kills off the weaker ones be­cause it was a very low dosage or be­cause the course of drugs was not fin­ished, the sur­viv­ing bac­te­ria will be the most re­sis­tant ones.

RE­SIS­TANCE

They will pass their re­sis­tance on to all their de­scen­dants, who will un­dergo sim­i­lar episodes of win­now­ing out the less-re­sis­tant ones many more times, and grad­u­ally, the re­sis­tance grows. The only way to keep an­tibi­otics ef­fec­tive, there­fore, is to use them as rarely as pos­si­ble and to make sure that they kill off all the tar­get bac­te­ria when they are used. We are not do­ing this. Doc­tors over­pre­scribe an­tibi­otics, of­ten giv­ing them to peo­ple who do not have bac­te­rial in­fec­tions just to get them out of their of­fices (and some­times get­ting a kick­back from drug com­pa­nies for each pre­scrip­tion they write). And no­body makes sure that pa­tients com­plete the course of treat­ment even though they al­ready feel bet­ter.

Much worse is the wide­spread prac­tice of giv­ing reg­u­lar low doses of an­tibi­otics to cat­tle, pigs, and chick­ens, partly as a means of con­trol­ling the spread of dis­ease in their cramped and un­san­i­tary liv­ing con­di­tions, but mostly be­cause it makes them put weight on more quickly. Get­ting them to the slaugh­ter­house a week or two faster is money in the hand.

This in­sanely greedy and reck­less prac­tice is now banned in the Euro­pean Union, but it is still com­mon­place in China and the United States. In fact, 80 per cent of Amer­i­can an­tibi­otic pro­duc­tion goes to farm an­i­mals who are not ill, and as in­ten­sive farm­ing meth­ods spread to de­vel­op­ing coun­tries, so does an­tibi­otic use in agri­cul­ture.

This has to stop. So does over­pre­scrib­ing by doc­tors in de­vel­oped coun­tries and the over-the­counter sale of an­tibi­otics with­out pre­scrip­tions that is so nor­mal in many de­vel­op­ing coun­tries. “We are now star­ing at over­whelm­ing ev­i­dence of ram­pant an­tibi­otic re­sis­tance, across all ages, all over the coun­try,” said Dr Vinod Paul, head of pae­di­atrics at the All-In­dia In­sti­tute of Med­i­cal Sci­ences in Delhi.

We also need a whole new gen­er­a­tion of an­tibi­otics to re­place those that are hope­lessly

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