How overuse of antibiotics is blunting our strongest weapons

Just as weapons lose their sharpness with repeated use, the frequent intake of antibiotics gradually weakens their effectiveness against infections. Bacteria gradually develop the ability to resist these medicines. And ours is a society where antibiotic resistance has reached alarming levels.

Consider this example: antibiotics such as Ciprofloxacin and Levofloxacin are commonly administered in the early stages to treat urinary pus and infections in the stomach and blood caused by Gram-negative bacteria (including E. coli). These bacteria have already developed 60–70% resistance to these medications.

Even against Carbapenem antibiotics, which are administered in the next stage of treatment, these bacteria have developed 30–40% resistance. Bacteria are now capable of resisting even those antibiotics prescribed when the illness becomes severe. In short, we are left with no effective weapon to deploy against them. 

Bacteria turn increasingly smart
Antimicrobial resistance, where bacteria develop the ability to survive antibiotics intended to eliminate them, is the greatest threat currently facing the healthcare sector. According to reports, by 2050, antibiotic resistance is expected to cause more deaths than cancer and road accidents.

Antibiotics eliminate bacteria by invading their cells. With frequent use, bacteria gradually acquire the genetic ability to block the entry of antibiotics into their cells and neutralise them. In short, bacteria will become smarter than antibiotics. 

Antibiotics and other medicines
What is the difference between medicines like paracetamol and antibiotics? Let’s consider the case of fever. An underlying infection may cause fever. In response to the infection, the body produces substances called `pyrogens.' These pyrogens reach the hypothalamus in the brain and alter the body’s temperature, manifesting in fever. 

The intake of medicines like paracetamol is aimed at eliminating pyrogens. Antibiotics, on the other hand, eliminate the very bacteria responsible for producing those pyrogens.

Antibiotics and efficiency 
Bacteria have developed increased resistance to certain antibiotics. Medications such as Ciprofloxacin, Levofloxacin, and Azithromycin fall into this category. On the other hand, bacteria have lower resistance to antibiotics like Septran and Amoxicillin. 

Since ours is a society more prone to infections, we cannot completely do away with the use of antibiotics. When antibiotics are used, the entire course must be completed. Only then can the bacteria be fully eliminated. Otherwise, the bacteria may survive and become active during the next infection. 

Bacteria or virus? 
When a patient seeks treatment for a cold, it is important to determine whether a virus or bacteria cause it. Tests to identify the cause are expensive, whereas antibiotics are much cheaper. As a result, without even proper testing, antibiotics are administered even for illnesses caused by viruses. 

In the past, training for health workers did not cover the subject of antibiotic resistance. As a result, the practice of prescribing antibiotics continued. Although that trend has changed, the use of certain antibiotics has now become inevitable due to the resistance capabilities developed by bacteria. 

Our environment is replete with antibiotics, as they are used in animals and agricultural practices. It is argued that, to combat antibiotic resistance, their use should be regulated across all sectors.

Change through blue cover
People desire a speedy recovery from illnesses, and there is a tendency to demand antibiotics from doctors. The earlier practice of dispensing antibiotics over the counter at medical stores without a doctor’s prescription has now changed. A law in the state also prohibits medical stores from selling antibiotics without a valid prescription. 

Antibiotic Stewardship, aimed at controlling antibiotic resistance, has been implemented in all major hospitals across the state since as early as 2014–15. More recently, the practice of dispensing antibiotics in blue covers, enabling patients to identify them easily, has also been introduced in hospitals. This is a notable initiative toward raising public awareness. 

Taking precautions against falling ill is crucial in the fight against antibiotic resistance. Incorporating the flu vaccine and pneumococcal vaccine into the state's vaccination programme will help prevent infections, thereby reducing the use of antibiotics. 

What happens on taking paracetamol with antibiotics? 
A recent study conducted by the University of South Australia found that taking painkillers such as Ibuprofen and Paracetamol along with antibiotics can increase bacterial resistance to antibiotics. This may come as a surprise to many of us who commonly take medications like Paracetamol alongside antibiotics. 

However, one need not be overly concerned by findings based solely on a laboratory experiment. The study did not account for the changes caused by bacteria within the human body. Moreover, not all antibiotics were examined in the study, which focused only on Ciprofloxacin. 

Ciprofloxacin belongs to the category of antibiotics against which bacteria have developed increased resistance. The only valid interpretation of the study is that it becomes far less effective when used with medications like Paracetamol. This does not imply that Paracetamol or Ibuprofen should be avoided with all antibiotics. 
(The author is an associate professor in the infectious diseases department of the Amrita Institute of Medical Sciences, Kochi)