Superbug Threat: A ticking Bomb

One of the landmark scientific achievements of 20st century has been the discovery of antibiotics. Antibiotics have redefined healthcare and for centuries now, have been helping doctors in saving precious human and animal lives. However, antibiotics have now become a victim of their own success. Due to their non-judicious and blind use, we are now facing a new dangerous healthcare challenge.

The emergence of ‘superbugs’ or antibacterial-resistant strains and species, now contribute to the emergence of diseases that were for a while well controlled. For example, emergent bacterial strains causing tuberculosis (TB) that are resistant to previously effective antibacterial treatments, pose many therapeutic challenges. Every year, nearly half a million new cases of multidrug-resistant tuberculosis (MDR-TB) are estimated to occur worldwide. For example, NDM-1 is a newly identified enzyme conveying bacterial resistance to a broad range of beta-lactam antibacterials. The United Kingdom's Health Protection Agency has stated that "most isolates with NDM-1 enzyme are resistant to all standard intravenous antibiotics for treatment of severe infections. It is estimated that annually there are around twenty five thousand deaths in European union due to antibiotic resistance. World Health organisation (WHO) has expressed concern on development of antibiotic resistance in serious terms. Many of the drug treatment breakthroughs of the last century could be lost through the spread of antimicrobial resistance. As a result, many infectious diseases may one day become uncontrollable and could rapidly spread throughout the world. Gravity of the situation can be gauged from the fact, recently chief medical officer of Britain said that antibiotic resistance is as big a risk as terrorism.

According to WHO, main causative reasons are underuse, overuse and misuse of antibiotics, lack of quality medicines (by exposing patients to sub-optimal concentration of anti-microbials) and animal husbandry. Animal husbandry is proving to be a serious source of anti-microbial resistance. In a study conducted in United States, US CDC and USFDA, found that almost 80% antimicrobials manufactured by pharmaceutical companies are sold in the veterinary segment for sub-therapeutic purposes. Sub-therapeutic use of antimicrobials (Sub-therapeutic doses of antimicrobials are used in animal-rearing for promoting growth or preventing diseases) have led to the development of superbugs. Such superbugs (resistant microorganisms) are transferred from confined animal feeding operations to general human population via food; this is a sure recipe for dangerous public health disaster. This is only one tip of the iceberg; one can only imagine the situation in less regulated livestock and human healthcare segments in developing and underdeveloped countries. In view of this emerging scenario, USFDA, OIE and WHO recommend a total ban on subtherapeutic use of antimicrobials. EU has banned the use of antibacterials as growth-promotional agents since 2003. Moreover, several organizations (e.g., The American Society for Microbiology (ASM), American Public Health Association (APHA) and the American Medical Association (AMA)) have called for restrictions on antibiotic use in food animal production and an end to all non-therapeutic uses. Many of the European countries have banned AGP ‘S and Several Asian countries are also planning to follow the move.

Human and veterinary medical sectors in South Asia in general and India in particular, present a dismal picture. Though perhaps there is limited or little credible data available on the prevalence of superbugs or the overall drug resistance, but a highly fertile breeding ground for superbugs is already there. Overuse, misuse and underuse of antimicrobials is very common medical and veterinary practice by quacks, self-prescription and lack of quality medicine have made the situation very grave. Sub-therapeutic use of antimicrobials (antibiotic growth promoters) by livestock producers is widespread. Then there is a total lack of effective legislation to regulate antibiotic use particularly in livestock. Concerned departments and agencies seem to be totally unaware and ignorant of this situation. We are sitting on an active public healthcare volcano.

Need of the hour is to spread awareness on this issue, introduce suitable legislative and regulatory policy measures on the use of antibiotics particularly in livestock and poultry. We need to adopt sustainable livestock husbandry practices. This concept of sustainability i.e., capacity to endure requires the reconciliation of Environment, social equity and economic demands. it is special responsibility of veterinary and medical research institutions, medical doctors and vets to work in close coordination, develop, introduce and popularise alternatives (Phytochemical bioactives, pre and probiotics, antimicrobial peptides, phages) while prescribing antimicrobials judiciously and with responsibility. Medical and veterinary practitioners need to follow a simple rule”. The first rule of antibiotics is try not to use them, and the second rule is try not to use too many of them. (Paul L. Marino, The ICU Book). In livestock there is a need to develop, promote and use alternatives to antibiotics and harmful chemicals. Such alternatives should not create selection pressure leading to the problem of microbial resistance. We have to make alternative strategies to prevent and control disease in livestock, which will be a critical component of our efforts to alleviate poverty and world hunger on one hand and will also ensure that standard treatments remain effective, infections doesn’t persist and spread to others.