Hotbed of antibiotic resistance

WITH all the attention placed on the Zika virus these past couple of months, it is tempting to think that this virus is the most pressing public health threat currently facing the country.

Viewing images of babies born with congenital microcephaly, a severe birth condition where they have abnormally small heads and underdeveloped brains, to mothers infected with the Zika virus can be particularly emotional even if you are not pregnant. Testing positive for this mosquito-borne virus can be devastating, knowing the risk it poses in pregnancy.

In adults, Zika virus infections have been linked to Guillain-Barré syndrome, a rare neurological disorder where the body’s immune system attacks part of the nervous system.

With hundreds of cases now reported in neighbouring Thailand and Singapore, increasing numbers of suspected infections in Malaysia and the looming inevitability of local Zika virus transmission, it is not surprising that all hands are on deck to prevent its spread, manage infected cases and deal with the socio-economic consequences of the epidemic.

However, the Zika virus which was actually discovered in 1947 is not as big a threat as the lurking menace which exists in the very places where we seek medical assistance such as in hospitals, clinics and in communities – the overuse and indiscriminate application of antibiotics for treatment.

Alexander Fleming, who discovered the world’s first antibiotic substance, actually recognised this threat during his acceptance of the 1945 Nobel Prize in Physiology or Medicine. “There is the danger that the ignorant man may easily underdose himself and by exposing his microbes to non-lethal quantities of the drug make them resistant,” he said.

Today, there is an emerging crisis of waves of new strains of antimicrobial-resistant bacteria which render existing antibiotics ineffective and useless. Infections have become increasingly unresponsive, or less susceptible to normal treatments, resulting in prolonged illness and greater risk of death.

The approach to disease management has increasingly been to use more sophisticated and toxic classes of antibiotics.

The worldwide emergence of methicillin-resistant Staphylococcus

(MRSA) in the 1960s was certainly a warning for what was to come. The increasing incidence and prevalence of MRSA in healthcare and community settings in almost every country in the world since then gives an idea of the enormity of the task at hand. MRSA is no longer resistant to just methicillin but has also become multi-drug resistant (MDR) to a wide range of antibiotics, severely limiting treatment options.

People with MRSA are estimated to be 64% more likely to die than people with a non-resistant form of the infection. The World Health Organization has already stated its fear of a “post-antibiotic era in which common infections and minor injuries, which have been treatable for decades, can once again kill”. It is sobering to hear from WHO that even a common disease like gonorrhoea may become untreatable.

Antibiotic resistance is a growing public health burden where worldwide, drug-resistant infections kill an estimated 700,000 people annually. More people are expected to die each year from drug-resistant infections and related complications than those with Zika virus infection which is non-fatal.

The cost of healthcare will certainly increase as more expensive and stronger classes of antibiotic treatments are required, lengthier hospitalisation and longer-term and more intensive care is needed.

The cause and proliferation of this threat directly related to the rate of antibiotic use in the community can best be understood within the Malaysian context. This country is fast becoming one of the frontlines of this global struggle.

The National Surveillance on Antibiotic Resistance has indicated that we have almost every variety of antibiotic resistance thus far documented, and some which have not yet made an appearance in other parts of the world.

A recent finding by the European Molecular Biology Laboratory detected the presence of a gene (MCR-1) which confers resistance to colistin, an antibiotic known as the drug of “last resort”, in bacterial samples from Malaysia.

First discovered among animals, the resistance has already made the inter-species leap to humans. Despite its toxicity, doctors are forced to use colistin as resistance continues to mount. One day, even this drug might no longer be an option.

Unfortunately, there are few new effective antibiotics in the pipeline after colistin. The arsenal of treatment options is steadily depleting, particularly with pharmaceutical companies limiting or stopping their investments in antibiotic innovation.

Recently, news broke of a Malaysian researcher at Melbourne University whose approach to the problem went outside the box. Though years away from commercialisation and public use, her research has the potential to create a new classification of antimicrobial drugs which could be an alternative to antibiotics.

This is the kind of innovation in cutting edge medical research and development which is desperately needed and should be encouraged and supported.

Malaysia has not been a shrinking violet in participating in crucial clinical trials for new and innovative approaches to disease prevention and management. The Government has introduced policies intended to make the country a preferred clinical research destination.

But we still need to do better by making available those same innovations once they have been cleared for public use. What is the point in participating in clinical trials for innovative and cutting edge drugs and treatment approaches but later denying their use and availability for Malaysian patients? AZRUL MOHD KHALIB Kuala Lumpur