To keep our antibiotics working

Imagine a world without antibiotics. Common illnesses, injuries and medical procedures may become life-threatening. HIV would once again be deadly. Far more patients would succumb to tuberculosis. Childbirth would be much more dangerous, for both mother and child.

If we don’t get our act together, this world could become our reality.

Since their discovery, antibiotics have served as the cornerstone of modern medicine. However, the persistent overuse and misuse of antibiotics in human and animal health have encouraged the emergence and spread of antibiotic resistance, which happens when microorganisms, such as bacteria and fungi, develop the ability to stop an antimicrobial, or multiple antimicrobials, from working against it. As a result, infections can grow and even spread to others.

The emergence of antimicrobial resistance (AMR) is creating “superbugs” that make treating basic infections difficult (and in some cases impossible) and surgery risky. Projections suggest that by 2050, more people will die of bacterial infections than cancer. AMR has become a major health threat, leading the UN General Assembly to include AMR as a priority health issue tackled alongside responses to Ebola and human immunodeficiency virus or HIV.

The misuse and overuse of antibiotics are accelerating the process of antimicrobial resistance beyond the speed of medical research. And though the emergence of resistance in microorganisms is a continuous phenomenon, its amplification and spread are the result of one thing: human behavior.

Factors unique to the Asia Pacific make the region an epicenter for AMR—including regulatory laxity, socio-economic conditions and demographics. We are already seeing the consequences with the rise of multi-drug resistant TB (MDR-TB), and the resort to prohibitively expensive intravenous medicines just to treat pneumonia. Taken together, these developments have dire medical, social and financial consequences for families and nations alike.

So what can we do? Doctors need to do a better job of explaining to people why they really need to take every single pill. Failure means not only that the germs will come back, but also that they will come back worse, and next time we can’t use the same drug. Once we’ve gone through the few drugs that we have, there’s no other alternative.We should also use vaccines more, because vaccination is a very effective way to stop various infections, thus preventing the need for antibiotics. Making better use of existing vaccines and developing new vaccines are important ways to tackle antibiotic resistance and reduce preventable illness and deaths.

There are steps the pharmaceutical companies can take as well. One is to make the courses shorter. Azithromycin, for example, is now on a shorter course, raising the chances the people will stick with it to the end. Veterinarians and animal health practitioners should prescribe antibiotics only when needed—right drug, right dose, right time, right route, right species, and right patient.Farm owners must apply good animal husbandry practices and use antibiotics only when prescribed by a licensed veterinarian.

Drug distributors and retail stores, on the other hand, should likewise share in the responsibility of fighting AMR, primarily in ensuring that antibiotics have proper prescriptions before they are sold.

Policies should be in place for human and veterinary surveillance of antimicrobial resistance and antimicrobial use. Above all, we need to keep spending on research and development to develop new generations of antibiotics. To its credit, The Philippine government was one of the first countries to answer the call for action against the threat of AMR, creating an Inter-Agency Committee for the Formulation and Implementation of the National Action Plan to Combat Antimicrobial Resistance in the Philippines in 2014. This and other initiatives require further support and commitment if we are to avert the further spread of antibiotic resistance—and keep our antibiotics working.

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Melvin Sanicas (@Vaccinologist) is a public health physician specializing in vaccines and infectious diseases. Gideon Lasco (@gideonlasco) is a medical anthropologist and Philippine Daily Inquirer columnist.