Sanjana Jha

Antibiotics are a type of medicine or antimicrobial substance active against bacteria. They are powerful drugs that are used to kill or limit the growth of bacteria. There are two types of drugs, First Line Drugs and Second Line Drugs. But nowadays we are facing the biggest public health challenges regarding antibiotic resistance.
I, being a student of medical microbiology, have found that “Drug Resistance is becoming common in patients nowadays.” Antibiotic resistance is the capacity of bacteria or other microbes to resist the effects of antibiotics. Drug resistance or antibiotic resistance simply means developing resistance among microorganisms, sometimes called ‘superbugs’.

It happens when microbes like bacteria and fungi do not respond or resist the drugs or medicines which are designed to kill them. Antibiotic resistance is a sub-category of Antimicrobial Resistance (AMR).
Beta-lactam antibiotics are the most widely used class of drugs for bacterial treatment, which include penicillin and its types such as Amoxicillin and other antibiotics as Mobactams around the world. If we talk about Nepal antibiotics like Tetracycline, Enrofloxacin, Neomycin, Doxycycline, Levofloxacin, Colistin, and Cytosine with Ampicillin, Amoxicillin, Ceftriaxone, and Gentamicin are widely used.

Irrational Use
Antibiotic resistance has become a global issue as it's harder to treat a growing number of diseases because of its resistivity towards microbes. According to WHO, only 6 out of thirty-two antibiotics are innovative to use. Lack of access to quality antibiotics is another burning issue. Children at a young age consume high doses of medicine, what if they face any serious problem in future? Consuming high dose medicine at an early age shows no response or less effectiveness later which travels our life to risk.

The general intake of antibiotics for common health issues has increased the rate of drug resistance among the patients. Out of 100%, around 75% of patients had developed resistance towards antibiotics. Our country Nepal is a major contributor to antibiotic resistance because of the irrational use of antibiotics along with several other reasons. There can be several reasons for drug resistance. Some of them are:-

Doctors sometimes prescribe antimicrobials “just in case,” or they prescribe broad-spectrum antibiotics when a specific drug would be more beneficial. Using these medications can increase the chance of drug resistance.
By not completing intake of antibiotics course, which can sometimes lead to surviving microbes and can cause resistance to certain drugs.
People suffering from the critical disease are often given high doses of antibiotics. This encourages the spread of microbes.
Sometimes microbe’s nature also increases the chance of drug resistance.
Overuse of antibiotics.

Not maintaining proper hygiene and sanitisation.
Poor health care system.
Lack of clean water.
Lack of awareness.
Poor infection control in hospitals and health care sectors.
Overuse of antibiotics in fish farming and agriculture.
We had a survey where it was found that most of the patients admitted in ICU have already developed 'First Line Drug Resistance'. The first-line drug refers to first administered for diseases and is usually chosen due to fewer side effects and high clinical effectiveness.
A drug that is the first choice for treating a particular condition as it is considered a very effective treatment for that condition with the least likelihood of causing side effects is called a first-line drug. It is also known as a single drug.

When first-line drugs do not respond or are not found effective then the second line of drugs are introduced to the patients. And the treatment done by using antibiotics is known as antimicrobial chemotherapy. Just because of this doctors or health workers always start treating with second-line drugs as they know we have become resistant towards first-line drugs by starting consuming them at our early stage of life.
People nowadays use antibiotics from a very early age. Sometimes antibiotics are prescribed for common diseases as well, because of which that particular antibiotic becomes resistant and it will be hard to treat dangerous diseases in future. Taking antibiotics at an early stage can make us resistant to ‘Second Line Drug Resistance’ as usual.

If medicines do not work during a severe case, patients can die as well. So far intake of antibiotics should be limited and can be used during the time of serious diseases. Here is a sample (pus) of an ICU patient who has developed ‘Second Line Drug Resistance’ after doing an antimicrobial susceptibility test.

The disk diffusion method has been used where ten white pellets of various antibiotics are placed on the Mueller-Hinton agar plate. Around two of the pellets, there is a lack of bacterial growth and the rest are showing antibacterial resistance. It clearly shows that medicines given to the patient don't work because of resistivity which he has developed towards medicine for any reason. It always leads patients as well as doctors with no choice.

Many patients have developed drug resistance to second-line drugs as well in the present time which ends up taking their lives. So, all of us should practise methods that help us to prevent antibiotic resistance. Proper immunisation, maintaining sanitisation and hygiene, drinking clean water, preparing food in safe ways, practising safer sex, avoiding near contact with sick people, washing hands frequently, doing yoga, etc can help us to prevent antibiotic resistance. At the same time try to consume fewer antibiotics or have it as per the need (prescribed by the doctor).

Proper Diagnosis
We generally use to consult people from different fields for their respective works besides doctors, for example, teachers for teaching, chiefs for cooking, engineers for construction works, mechanics for repairing vehicles, and so on but in case of medical problems we don't prefer to go for a check-up rather we follow the medical advice given by family members, relatives, friends whether they are not from the medical field.

You might have heard ‘Everyone is a doctor in Nepal' so they go on prescribing medicines on their own. And that's a major reason for the excessive use of antibiotics in our country. Don't we think this will create more variants of microbes and can be challenging for medical experts? Let's diagnose first before using any drugs and help ourselves to get rid of antibiotics resistance.
Thus, It’s better to be safe than sorry.

(Sanjana has obtained Masters' degree in Medical Microbiology)