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The antibiotic crisis: An altered approach

Vandana Kohli

Updated: July 14, 2014, 12:30 PM IST
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Bacteria mutate. They alter their DNA to change the permeability of their cell wall, change shape or the protein they are excreting,in order to survive an onslaught coming their way. Mutation is an inbuilt ability, a mechanism for survival, worked out over millions of years by these original life forms. Mutation is also a way for nature to maintain homeostasis - her inherent balance.

The power to mutate makes bacteria resilient to antibiotics. Overnight, one resistant bacterium can multiply to become a million. Additionally, resistance can also be passed on from one strain of bacteria to another.

New strains of bacteria are emerging, with greater resilience, to render our known knowledge of antibiotics increasingly ineffective. Much of the modern world is watching with alarm, with one expert calling the issue "a ticking time bomb". At a recent G7 meeting, Prime Minister David Cameron of the UK has highlighted concerns and the urgent need to step up the discovery of new antibiotic drugs.

The cause:

But what is causing bacteria to mutate and become increasingly resistant to drugs? Ironically, it is the use of antibiotics. The more we use, overuse and abuse these drugs, the more resistant bacteria become.

Australia accounts for the largest antibiotic prescriptions issued to its population of 16 million. In the US, an estimated one fourth of prescriptions are unnecessary. Data for developing countries is not exact, but there is little caution being exercised in prescribing these drugs.

Often, antibiotics are prescribed for viral infections, which is unwarranted. The more indiscriminately we take them, the more our immunity is adversely affected, heightening in turn our need for stronger drugs.

In cases where they are appropriate, a patient may fail to complete the course. This allows the bacteria in his or her body, not yet completely wiped out, to mutate and become resistant to the drug. Antibiotics also wipe out friendly bacteria, which would otherwise compete with the resistant strain for resources.

Another cause attributed to resistance is the overuse of antibiotics in animals. More resilient strains get passed on from animals to humans, with the medical community then scrambling to control the infection from becoming an epidemic.

Challenges:

It's an unrelenting situation. The more we fight with what we think will kill it, the stronger the bug ultimately becomes.

Though research for new drugs has been underway, no significant molecule has been found since 1987, after the discovery of Lipopeptides. GlaxoSmithKline, in nearly twelve years of research, with close to a billion dollars spent, has found one drug for bacterial skin infections. It's an expensive proposition with small returns for pharmaceutical firms, since antibiotics retails inexpensively.

Yet, a greater challenge is approach. Modern medicine is primarily reductionist, a position which holds that a complex system or organism is no more than a sum of its parts. Finding those parts, therefore, involves looking for smaller and smaller components that make up an organism. Here is where a shift in paradigm may help.

A different approach:

Staphylococcus Aureus, for instance, is bacteria, which lives on the skin of healthy people, without usually causing illness. It infects a person through an open wound or broken skin. However, Staph aureus has become infamous as MRSA - Methicillin-Resistant Staphylococcus Aureus. Resistant to all but the most powerful antibiotics, MRSA is often called the "Superbug", owing to its increased tenacity. The risk of maximum infection from MRSA is in hospitals.

Studies have indicated that the way to combat MRSA is not through administering stronger and stronger drugs, which is an immediate though short-lived solution, but rather by drawing attention to the root cause for its spread. In effect, better hygiene is lauded as the main weapon against MRSA.

It's a different approach, stepping away from the reductionist perspective to look at a more fundamental, encompassing and enduring solution.

Interestingly, a new approach to combating bacterial infections is to disarm the bug by permeating its cell wall rather than by killing it outright. Here too, scientists have found certain components from Japanese green tea that can be inserted into the membrane of MRSA.

Traditional knowledge:

These are pointers towards systems of traditional medicinal knowledge and perspectives that lie functionally in much of Asia, Africa and parts of South America. Southeast Asia, in particular, is rich in its understanding of active ingredients in herbs and plants and what they may cure. Vietnam, Cambodia, Thailand, China, India, Korea and Japan abound in such knowledge.

Most of such systems focus on building the body's immunity, as a root solution. Additionally, their approach is not to segregate the active ingredient from the plant, but rather to offer the plant or herb as a whole in a prescribed quantity to the patient. The belief is that the plant has other ingredients that naturally balance out any side effect the active ingredient may cause.

Through information documented and codified often over a few millennia, there is a trove of leads and possible solutions to more sustainable, effective and less intrusive alternatives for global health within traditional systems of medicine.

Collaboration:

Experts from modern medicine may find it useful to collaborate with genuine practitioners of traditional medicine. A first step to make this possible is to understand that traditional systems work within a different paradigm altogether. Appreciating this difference would open the way to sharing information, with mutual regard, in the common pursuit for better health.

India, in particular, could collaborate and contribute in additional ways. Indian scientists, doctors and engineers are acknowledged and appreciated for their work throughout the world. Human resource could therefore be one contribution to the team looking for new drugs.

Again, India, with its tropical climate and varied ecosystems, is abundant in biodiversity. Scientists, both native and foreign, may find it exciting to look for new molecules for a new set of antibiotics within the larger Indian sub-continent.

What we can do individually:

Much of modern medicine is emergency medicine. It should be relied on during an emergency. To build and maintain immunity, traditional and organic knowledge, which include Ayurveda and homeopathy, may offer more lasting solutions.

Avoid antibiotics as much as possible. When prescribed, completing the course to the last dose is imperative. Stress hygiene at home and work. Children should be asked to wash their hands often, especially with them sharing each other's gadgets and devices indiscriminately.

Offices need to be more alert and flexible in exercising their policy for sick leave. With central air-conditioning in offices, slight infections usually spread rapidly. People with infections should be requested to work from home, if necessary, till they have recovered completely.

This is a global crisis. A way ahead reflects in Gandhi's aphorism - Think globally. Act locally.

Vandana Kohli

The author is a filmmaker, writer and photographer, with projects and extensive research in mental health, biotechnology and issues of social relevance.

First Published: July 14, 2014, 12:30 PM IST

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