Download Over-prescription of antibiotics now threatens the future health of millions and more Essays (university) Biology in PDF only on Docsity!
‘Over-prescription of antibiotics now threatens the future health of millions’. Analyse and discuss this statement with reference to specific examples, using a range of academic sources. Antibiotics work as antimicrobial agents, killing or inhibiting the growth and reproduction of microorganisms, serving as a cure for bacterial infections.^1 Humans have looked towards curing disease from the beginning of civilisation. Ancient Chinese and Egyptian physicians are known to have used mouldy tofu and bread, pressed against wounds to prevent infection.^2 This treatment for wounds might not have been as effective as treatment is today with the availability of modern medicine. However, the antimicrobial effects of these substances are undeniable. Even without the modern knowledge of drugs and treatment, people sought a way to treat sickness. The survival instinct to stay alive, no matter the cost, could be a cause of the abuse and over-prescription of antibiotics, which in turn has repercussions of antimicrobial resistance that we face today. The previous cure to microbial infections may not be as much of a “magic bullet” as it used to be.^3 The first antibiotic, arsphenamine (Salvarsan), was released to the public in 1910. Following this discovery, in 1924, the first case of clinical antimicrobial resistance was reported; four years before the more widely known penicillin was discovered. 4 Antimicrobial-resistant bacteria have been known about and yet since then, antimicrobial resistance has become an increasing problem as the treatment is becoming increasingly more complicated. Most antimicrobial agents fit into four major “modes of action”: (1) interference with cell wall synthesis, (2) inhibition of protein synthesis, (3) interference with nucleic acid synthesis, and (4) inhibition of a metabolic pathway.^5 Spontaneously, bacteria can undergo gene mutations, which can lead to antibiotics becoming less effective or completely ineffective in some cases. With the great number of bacteria and rate of reproduction, DNA mutations are inevitable. (^1) (Lancini, et al., 1995) (^2) (Bennett, 2020) (^3) (Cascioferro & Schillaci, 2014) (^4) (Silberstein, 1924) (^5) (Tenover, 2006)
A study was conducted in Karachi, Pakistan, looking into the use and prescriptions of antibiotics given by 500 dentists spread out within the private and public sectors.^6 This study showed that 82.9% of practitioners admitted the drawbacks that over-prescribing causes, including the resistance of evolving bacteria strains. However, antibiotics were prescribed 90% on account of the recommended doses, as stated in the BNF.^7 From low-income countries to high-income countries there is a worldwide practice of the improper use of antibiotics. In the United States, at the beginning of 2016, there was new data to show that one in three, or 30% of prescriptions for antibiotics were unnecessary.^8 Of this 30%, most of these prescriptions were for conditions caused by viral infections. Knowing this shows how inappropriate some of these uses of antibiotics are. Not only is this promoting the reproduction of antimicrobial-resistant bacteria, but this is also putting patients at unnecessary risk of anaphylaxis, leukopenia and thrombocytopenia, nausea, gastrointestinal disorders, neurologic side effects and drug fever which can account for 10% to 15% of unexplained fevers in hospitalized patients. This, in turn can put an avoidable strain on health services. Reducing the frequency of unnecessary prescriptions of antibiotics will decrease the number of patients who are admitted for fevers due to antibiotic use, freeing up beds for patients in more need and increasing the effectiveness of future prescriptions of antibiotics. The current antibiotic abuse is alarming, putting millions at risk of rapidly increasing populations of antimicrobial-resistant bacteria. In 2019, there were an estimated 4.95 million (3.62-6.57) deaths due to bacterial infections, of which 1.27 million (95% uncertainty interval (UI) 0.911-1.71) were associated with antimicrobial-resistant bacteria.^9 This demonstrates the problematic potential that these bacteria may cause in the coming future with the population increase of species resistant to an increasing number of antibiotics. “More than 70 percent” of bacteria which cause infections in humans may be resistant to at least one antibiotic which is used to treat them.^10 Methicillin-resistant Staphylococcus aureus (MRSA) is a species of bacteria resistant (^6) (Ikram, et al., 2015) (^7) (Roy & Bagg, 2000) (^8) (Prevention, 2016) (^9) (Anon., 2022) (^10) (Administration, 2016)
countries in WHO European Region said that the antibiotics they were taking or had taken were from leftover prescriptions or obtained without a prescription at all.^16 This means that patients are not taking the correct antibiotics and the doses specific to certain species of bacteria. The antibiotics the patient is taking may be completely ineffective, harming the patient with no benefit. Our bodies have natural defences against infection. Although in many cases this is not enough to kill the infection, the over-prescription of antibiotics kills natural gut flora, which includes many species of harmless microorganisms, as well as killing invasive, dangerous bacteria. This gut flora serves as a competitor, increasing the difficulty of survival for the infectious bacteria. With the reduced population of gut flora, it becomes easier for dangerous bacteria to grow and reproduce inside the body, leading to an increased infection rate. This is another reason why the over-prescription of antibiotics has minimal positive side effects. Although the information is public about how the over-prescription of antibiotics is affecting the future health of millions, there is a continuous increase in the consumption of antibiotics. In low-income to middle-income countries, rates of consumption have skyrocketed, observed between 2000 and 2018, increasing by 76%.^17 Assuming that the data is accurate to this study; 31.8% of these patients will be noncompliant. This is a big number of patients, putting themselves and millions of others at risk who are more susceptible to developing severe symptoms of infection. Today’s global problem of over-prescription and inappropriate use of antimicrobial agents will have implications lasting that will affect the current treatment of bacterial infections. Antibiotics are losing the potency they once had and are on a downward trajectory to becoming ineffective against potentially life-threatening microorganisms. The information is available and accessible to most of the world’s population. Through education and coverage, the dangers of ignoring antimicrobial resistance can be taught to positively affect future generations, who are currently destined for an age where bacteria need increasingly (^16) (Organisation, 2022) (^17) (Browne, et al., 2021)
complex treatment. There is a fear that bacteria could once again become untreatable, threatening the future health of millions. Surgeries may become too dangerous to perform, where the risk of untreatable infection is too high. It is estimated that antibiotics have increased life expectancy by as much as 20 years.^18 There are now 3.5 deaths per 1000 live births, whereas before antibiotics the figure was 1 death per 10 live births. To think that the increase of antibiotic resistant bacteria could decrease general life expectancy is something that should be more alarming than it seemingly is. The survival instinct will continue, but patients should not demand the prescription of antibiotics and should not take it upon themselves to take antibiotics as a remedy to general illness. Each antibiotic works in a specific way to treat a specific species of microorganism.
References:
Lancini, et al., 1995: , (Lancini, et al., 1995), Cascioferro & Schillaci, 2014: , (Cascioferro & Schillaci, 2014), Bennett, 2020: , (Bennett, 2020), Silberstein, 1924: , (Silberstein, 1924), (^18) (Staples, 2018)
