There was a time around the middle of the last century when it seemed that humans could decisively vanquish the microbes that caused so many dreadful, often deadly, diseases. But that sense of victory over an enemy has given way to alarm. Drug-resistant pathogens have sprung up and ‘superbugs' that can shrug off most drugs that are thrown at them have surfaced and spread across the world. With few new antimicrobials under development, there is a real sense among medical experts of humanity having its back to the wall and of the frightening possibility of a return to the bad old days when what started as a simple infection could get completely out of control. This year's World Health Day (April 7) focusses on antimicrobial resistance and its global spread. In a highly interconnected world, drug-resistant microbes can leap from one country to another. Last year, there was a furore over the spread of highly drug-resistant bacteria, which had the New Delhi metallo-beta-lactamase (NDM-1) gene, from South Asia to several countries. But ‘superbugs' have made their way to India from elsewhere in the world too. For instance, studies of methicillin-resistant Staphylococcus aureus (MRSA) bacteria isolated in India have indicated a movement of such organisms from the United States, Europe, and Australia to this country.
In India, as in other countries, such dangerous microbes are circulating not only in hospitals but also in the larger community; poor sanitation and faecal contamination of water supplies have allowed some highly antibiotic-resistant bacteria to spread. Drug-resistance is a major issue in tuberculosis. India accounts for one-fifth of the global burden of the disease and two people die of it every three minutes. The rise of resistance as a natural consequence of the process of evolution is perhaps inevitable. But the misuse of antibiotics greatly hastens this process. There is a great deal that can and must be done to conserve the drugs that are available and still effective. Over-the-counter sales of antibiotics must be stopped. Physicians need to be educated on when it is appropriate to use antibiotics. Even when an antibiotic is needed, it is essential that the right drug is given at an adequate dosage and for a suitable duration. A proper system of surveillance for antimicrobial resistance as well as regularly updated guidelines for treatment would help doctors make the right choices. Further, the use of antibiotics as growth-promoters in livestock needs to be curtailed. In all of this, the government, the medical fraternity, and the public must play their part.