An­tibi­otic stew­ard­ship

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AT THE 103rd An­nual Clin­i­cal Congress of the Amer­i­can Col­lege of Sur­geons last week in San Diego, Cal­i­for­nia, I met sev­eral sur­geons from the Philip­pines who flew in to at­tend the ACS Congress. As a Fil-Am sur­geon, I al­ways en­joy and sa­vor meet­ing my col­leagues from my na­tive land. One of them hap­pened to be an old friend, Dr. En­rique T. Ona, for­mer sec­re­tary of Health of the Philip­pines. This yearly con­tin­u­ing sur­gi­cal ed­u­ca­tion event at­tracts hun­dreds of sur­geons from all over the world.

One of the hot top­ics at this in­ter­na­tional con­ven­tion was An­tibi­otic Stew­ard­ship, a vi­tal global pro­gram that could save hu­man­ity as a whole from deadly su­per­bugs that could wipe out civ­i­liza­tion, if not pre­vented or con­tained, an is­sue I have dis­cussed in a pre­vi­ous col­umn.

Ac­cord­ing to the World Health Or­ga­ni­za­tion, “an­tibi­otic re­sis­tance is one of the ma­jor threats to hu­man health, es­pe­cially be­cause some bac­te­ria have de­vel­oped re­sis­tance to all known classes of an­tibi­otics.”

Im­proper use

The United States Cen­ters for Dis­ease Con­trol and Pre­ven­tion (CDC) re­ported that “30 per­cent to 50 per­cent of pre­scribed an­tibi­otics in hos­pi­tals are ad­min­is­tered in set­tings where an an­tibi­otic is un­nec­es­sary or is in­ef­fec­tive against the path­o­genic or­gan­isms…. In­creased and in­ap­pro­pri­ate an­tibi­otic use leads to in­creased risks of an­tibi­otic re­sis­tance, as well as con­tribut­ing to clostrid­ium dif­fi­cile (C. dif­fi­cile) in­fec­tions.”

Pan­demic of su­per­bugs

While ter­ror­ism is hold­ing peace hostage around the world to­day, a more rampant but un­der the radar killer is on the loose and be­com­ing more wide­spread, wip­ing out lives, as the med­i­cal com­mu­nity help­lessly bat­tles this pan­demic sit­u­a­tion of su­per bugs re­sis­tant to all drugs we cur­rently have. Be­ing at the mercy of these pow­er­ful and de­fi­ant micro­organ­isms is a most scary sit­u­a­tion. And they seem to be ahead of us.

Pneu­mo­nia and wound in­fec­tions killed hun­dred of mil­lions of peo­ple glob­ally be­fore peni­cillin was dis­cov­ered in 1928 by Alexan­der Flem­ing, Pro­fes­sor of Bac­te­ri­ol­ogy at St. Mary’s Hos­pi­tal in Lon­don. To­day, these con­di­tions and hun­dreds of other in­fec­tions re­spond well to peni­cillin and the other more so­phis­ti­cated an­tibi­otics, sav­ings hun­dreds of mil­lion of lives ev­ery cen­tury ... un­til now, with the ex­plo­sion of su­per bugs!

Scary sta­tis­tics

At least 2 mil­lion Amer­i­cans de­velop drug re­sis­tant in­fec­tions a year and more than 23,000 of them die, 10 mil­lion deaths a year world­wide. This trans­lates to $100 tril­lion sac­ri­ficed gross na­tional prod­ucts. Most of these scary in­fec­tions oc­cur in hos­pi­tal set­tings, but they are also noted in the gen­eral com­mu­nity. These could be the com­monly known con­di­tions, like pneu­mo­nia or wound in­fec­tion, but this time caused by drug-re­sis­tant bac­te­ria, and hence, deadly. It is like retro-trans­port­ing us back to the early 1900, the prepeni­cillin era.

Lessons from the past

While two of the most dev­as­tat­ing out­breaks of the Black Death (plague) that wiped out more than half of the pop­u­la­tion of Europe in the 14th Cen­tury killing about 75 mil­lion, lead­ing to the fi­nal demise of the Ro­man Em­pire, was caused by two dif­fer­ent strains of in­fec­tious agents from the black rats, one drug re­sis­tant in­fec­tion to­day could kill much more around the globe.

Just like us, hu­mans, bac­te­ria are ac­tive liv­ing micro­organ­isms, with sur­vival “in­stinct,” and when ex­posed to the drugs that aim to kill them, have the ca­pac­ity to adapt by mu­ta­tion and repli­ca­tion to be­come re­sis­tant to the drugs, When they be­come su­per bugs, they are un­touch­able killers, un­less we de­velop new drugs ef­fec­tive against them.

Who to blame

How­ever, we can­not blame the bac­te­ria, who sim­ply want to sur­vive just like all liv­ing things. We, hu­mans, health­care providers and lay peo­ple, who abuse an­tibi­otics, are to blame. Whether pre­scribed in­dis­crim­i­nately or pur­chased over the counter by self-med­i­cat­ing in­di­vid­u­als, the wide­spread abuse of an­tibi­otics make the bac­te­ria mu­tate and grow re­sis­tance to them.

Cur­rently, there are at least six com­mon pathogens that are drug-re­sis­tant, Kleb­siella pneu­mo­niae, E. Coli, and MRSA, and 3 global dis­eases: HIV, TB and malaria. There are many oth­ers. Un­less sci­ence dis­cov­ers fast ways to fight and kill these re­sis­tant su­per­bugs with new drugs or method­ol­ogy and we, the peo­ple, do not abuse their use, any and all of them will con­tinue to kill with im­punity around the world.

Bac­te­ria are on ALL sur­faces

These micro­organ­isms are on our skin, on our en­tire body. They are also all around us, in all sur­faces, in our kitchen (which has more bac­te­ria than our bath­room), all over our home, and in all pub­lic ar­eas, like es­ca­la­tor hand rails, door knobs, cab­i­nets, mi­crowave oven door han­dle, coun­ter­tops, ta­bles, chairs, etc.. Pa­per money and coins are loaded with bac­te­ria. If bac­te­ria are on our skin and ev­ery­where, why do we not al­ways get in­fected? The rea­sons are fac­tors like our skin in­tegrity. If our skin is in­tact, the bac­te­ria can­not in­vade us, ex­cept though our mu­cus lin­ings (in our eyes, nose, mouth, ears, anus). This is where per­sonal hy­giene is es­sen­tial. Touch­ing our face con­tam­i­nates it with bac­te­ria. The other fac­tor is the type and dose (num­ber) of bac­te­ria. Even if we have a skin abra­sion or cut, if we thor­oughly wash the af­fected area right away, the dose of bac­te­ria will be so re­duced our im­mune sys­tem can han­dle them to pre­vent in­fec­tion. If the dose is not re­duced, then we get skin in­fec­tion. This is why all wounds must be washed clean im­me­di­ately af­ter sus­tain­ing them.

Sim­ple hand-wash­ing

On the pro­phy­lac­tic side, the sim­ple habit of wash­ing our hands re­li­giously, at least 8 times a day (af­ter go­ing to the bath­room, be­fore and af­ter eat­ing or work­ing around the house or out­side) can pre­vent con­tam­i­na­tion and in­fec­tions, elim­i­nat­ing the need for an­tibi­otics. This prac­tice can also pre­vent vi­ral in­fec­tions, like com­mon cold, for which some mis­in­formed or un­in­formed in­di­vid­u­als might opt to take an­tibi­otics. Vi­ral in­fec­tions do NOT re­spond to an­tibi­otics. This is just a waste of money, and worse, it will “en­cour­age” bac­te­ria in our body to de­velop an­tibi-

otic re­sis­tance. When treated longer than nec­es­sary, even bac­te­rial in­fec­tions com­monly sen­si­tive to spe­cific an­tibi­otics will in­crease the risk of the bac­te­ria de­vel­op­ing re­sis­tance. Skin san­i­tiz­ers, prefer­ably with skin mois­tur­izer, in liq­uid, gel or foam, are help­ful in min­i­miz­ing in­fec­tion. Those with sixty to 95 per­cent al­co­hol are most ef­fec­tive.

An­tibi­otic Stew­ard­ship is also our in­di­vid­ual re­spon­si­bil­ity as a mem­ber of so­ci­ety. Let’s all help pre­vent a su­per­bug pan­demic that could wipe us out of this won­der­ful world.

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