May 20, 2022

Overuse of antibiotics: towards a health catastrophe

Almost all clinically important and widely used antibiotics have lost their effectiveness by more than 50 percent, a recent study found – a development that may leave people defenseless against pandemics.

More worryingly, five of the most critical drugs listed by the World Health Organization are gradually becoming ineffective, according to the Institute of Epidemiology, Disease Control and Research surveillance study conducted between 2017 and 2021.

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“The message of this study is that the situation is alarming,” said Meerjady Sabrina Flora, deputy director general of the health department, during an event yesterday to unveil the performance of 21 antibiotics against 10 priority pathogens.

The drugs have been tested against bacteria that cause diseases such as urinary tract infections, sepsis, diarrhea, pneumonia, and wound infection, among others.

The study, which was conducted at nine university medical hospitals, found that 9 percent of the bacteria examined were resistant to all available antibiotics.

The ineffectiveness of antibiotics in killing microorganisms like bacteria, viruses and parasites is called antimicrobial resistance (AMR).

“AMR is another type of pandemic. It shouldn’t be because there is no medicine to cure disease,” Flora said.

The data indicates that antibiotic use is motivated by practitioners, said Nitish Chandra Debnath, national coordinator of One Health Bangladesh.

“We need to work on it – we need a strong movement among professionals. AMR is a challenge for both public health and the economy,” he added.

Antibiotics are classified into three sets: the “access group” is prescribed for a wide range of primary level infections, the “watch group” for more resistant bacteria, and the “reserve group” when all alternatives. fail.

Of the 21 antibiotics, seven belonged to the access group, nine to the surveillance group and two to the reserve group. Of these, 15 become progressively ineffective.

In 2021, Ceftazidime, a drug in the watch group, has become ineffective in killing different bacteria in 70% of cases. In 2017, its inefficiency rate was 62%.

Ineffectiveness decreased from 52% to 58% for cefixime, from 57% to 61% for cefepime, from 52% to 65% for ceftriaxone, from 57% to 67% for ciprofloxacin, from 20% to 40 % for carbapenems. All are watch group drugs.

During the period, the drugs of the access group Doxycycline and Tetracycline became more useful, their ineffectiveness rates decreasing from 47% to 39% and from 58 to 54%, respectively.

“This may be due to the lower use of these drugs – doctors mainly use drugs from the watch and reserve groups,” Zakir Hossain Habib, senior investigator and head of microbiology at IEDCR, told the Daily Star.

Among the access group, drugs that have lost their effectiveness include nitrofurantoin, sulfamethoxazole-trimethoprim, ampicillin, amoxicillin-clavulanate, and gentamicin. Penicillin has slightly increased in effectiveness.

The ineffectiveness of Aztreonam, a drug in the reserve group, increased from 59% to 61%; it remained static at 37 percent in the case of the drug from the reserve group Linezolid.

“We are losing our first-line antibiotics [access group] – second and third line antibiotics are expensive and toxic, ”said Mohamed Ramzy Ismail, WHO technical expert on essential drugs and drugs in Bangladesh.

There are only a few promising options for newer antimicrobials in the research pipeline, he said.

To combat AMR, Ismail called for the “One Health” approach, where Bangladesh has made good progress.

One Health recognizes that human health is closely related to animal health and the shared environment.

Some countries use antibiotics more in food production than in medical care.

“We need to find ways to target all behaviors that contribute to the abuse of these fragile drugs,” he added.