Can we win the war on bacteria?

“The time may come when penicillin can be bought by anyone in the shops. Then there is the danger that the ignorant man may easily under-dose himself, and by exposing his microbes to non-lethal quantities of the drug, make them resistant “

Alexander Fleming

We are now at the risk of entering a dark period called ‘the post-antibiotic era’, a time the World Health Organization (WHO) has described as one ‘in which common infections and minor injuries can kill again’. This scenario is a catastrophe for physicians and healthcare providers, and should be seen as such by governments and international policy makers.

Since 1980, we have been in a discovery void, a period where the medical community has ceased to discover new antibiotics, let alone invent them. Relying solely on old antibiotics, infectious diseases are now the second leading cause of deaths worldwide.

Is it possible to win a war against bacteria? From a realistic approach, the age, resistance abilities, ancient-programmed cellular adaptability, genetic plasticity and replicating powers of bacteria don’t allow us to say that we could. Having said that, let’s not close our eyes to the misuse of antibiotics by people, physicians, pharmacists and animal husbandry that gives more and more power to these greedy microorganisms.

Based on a recent study conducted by Cairo University, 59 per cent of antibiotics sold in pharmacies were with a prescription from a physician, while 30 per cent were dispensed after self-medication, and 13 per cent were prescribed by pharmacists on spot. The fallacies in prescription principles directly contribute to antibiotic resistance.

Unfortunately, this hazardous malpractice of antibiotics prescription by physicians is vastly increasing. For instance, in Egypt, a not-so-small percentage of doctors prescribe antibiotics for common colds, coughs, and minor wounds. This reflects how poorly aware our health care providers are of their role in the current crisis. The same applies to the prescription of vancomycin for methicillin sensitive staph by unaware doctors, rendering the drug weaker and more resistant for MRSA strains. Physicians in various hospitals likely do not strictly follow preventive instructions due to ignorance and lack of resources, resulting in a culture of poor antibiotic use documentation and failure to end reliance on the so-called treatment.

During my two years of practice in Alexandria Main University Hospital, I’ve witnessed 56 cases of Carbapenem-resistant cases that were only sensitive to colomycin and tigecyclene. This number is by all means frightening, but more frightening are the 21 cases of colistin- resistant cases detected in miniBAL and bloodstream samples in the ICU, which my colleagues and I have observed since August 2015. Aggressive microorganisms such as Acinetobacter, Klebsiella, MRSA, Pseaudomonas aeruginosa, and E-Coli are shamefully frequent residents in many of our hospitals.

Are we excused when it comes to immunocompromised patients? During one of my night shifts, a 19 year-old Leukemia patient who was a candidate for a bone marrow transplant developed septic shock. This precious patient impelled me and the rest of the team to reach a decision regarding his antibiotic use, and consider it as a potential life-saving measure. Colistin was added to his medication, and the patient died 30 hours later. The question of what’s right and what’s wrong in this situation is controversial, and it was certainly an eye-opening incident. Yes, each institution has its own Biogram, and customized antibiotic practice guidelines are permitted when patients are in an immunocompromised state. But what if I’m put in this situation daily? What if I need to give stronger antibiotics to my patients to try and save their lives? What consequence will this have on organisms’ behavior and resistance? I leave that to your imagination.

It’s no question that global action towards better practice is urgent. Antibiotic resistance isn’t only taking lives, it’s also limiting the successes of modern medicine and keeping governments from achieving their sustainable development goals. Hospitals are exhausting their resources and patients are bearing long, agonizing hospitalization stays as a result of our ignorance. To that end, the WHO, as described in a draft published in May 2015, encouraged an international movement urging governments, pharmaceutical researchers, health care providers, policy makers and, most importantly, the people to take action.

But how can you help? As a young promising doctor, the future of medicine lies in your hands. It is crucial to promote proper preventive measures in your locale.  If you advocate for multilevel action in your country and draft a customized plan with enthusiastic activists in your field, then the hope for combating lethal infections will rise again.