World Health: Antibiotic-resistant bacteria are a pandemic time no less dangerous than Corona virus

Excessive use of drugs impairs their effectiveness

The overuse of antibiotics is one of the vital issues that the medical community suffers from, as well as patients, especially inpatients, and those who have multiple health problems related to recurrent bacterial infections. Excessive use of antibiotics causes damage, the most important of which is “bacterial resistance to antibiotics” that occurs when bacteria acquire immunity to the effects of drugs, making it more difficult to treat common types of diseases and exacerbating their risk, sometimes leading to death.

The World Health Organization has warned that the growing resistance to antibiotics is no less dangerous than the Covid-19 pandemic, and threatens to undo a century of medical progress, and considers it one of the greatest health threats of our time.

- The miracle of antibiotics

spoke to Dr. Ashraf Abdel Qayyum, Amir, Vice President of the Saudi Society for Family and Community Medicine and a family medicine consultant at the International Medical Center, explaining the importance and preference of antibiotics over humanity in combating infections and infectious diseases, and that their discovery was a radical shift in the fight against bacterial diseases. Its beginnings and developments were as follows:

In 1928, the first antibiotic in the world was discovered by the Scottish scientist Sir Alexander Fleming when he noticed that the Penicillium fungus was able to eliminate some of the bacterial colonies that were adjacent to it and disrupted it from spreading through the secretion of some substances The chemical that was later considered the famous antibiotic "Penicillin".

> From 1900 - 1996, antibiotics made great achievements. During 96 years, the death rate due to infectious diseases decreased significantly, after it was about 700 - 800 deaths per 100,000 people per year, it decreased to less than 50 - 60 deaths. per 100,000 cases per year, and this indicates the development of antibiotics and their ability to eliminate a wide range of problems related to bacterial infections.

> Antibiotics are credited with reducing the death rate due to infectious diseases in contrast to our inability, so far, to control non-communicable diseases, i.e. chronic diseases such as diabetes, hypertension, asthma and heart diseases, which still record high mortality rates of more than 900 deaths per 100 thousand people a year.

> In 1999, one of the studies conducted by Dr. Armstrong and colleagues and published in the journal JAMA showed the power of antibiotics in eliminating one of the serious diseases in children, bronchopneumonia, and the death rate in infected children decreased and their cure rate increased from 25% to 80 percent thanks to these antibiotics.

> The role of antibiotics in saving the lives of many patients from the category of newborns, transplants of organs such as kidneys, patients with cancerous tumors who receive chemotherapy that lowers the body’s immunity and exposes them to opportunistic infections, as well as patients who take some immunosuppressants, and patients who undergo surgeries complex and thus they are vulnerable to bacterial infections after surgery, in addition to patients in intensive care. Indeed, these medicines, God willing, have been able to save the lives of many of them and preserve their safety.

- Bacteria resistance

Sir Alexander Fleming stated, in 1945, that it is not difficult for bacteria to resist an antibiotic (penicillin) if exposed to insufficient concentrations of it to kill it, and thus there is an opportunity for bacteria to cause genetic changes in it and the emergence of a generation of bacteria that are resistant to antibiotics. He stated that this resistance that occurred in laboratories can also occur inside the human body.

Dr. Ashraf Amir adds that indeed, the medical community and international organizations have been surprised by the emergence of antibiotic resistance by some types of bacteria due to the overuse and misuse of antibiotics, despite the remarkable successes that have occurred and the ability of antibiotics to contain health problems, diseases and bacterial infections.

In the first decades of the 1930s, antibiotics retained their effectiveness in eliminating bacteria for long years after their discovery, up to 20 and 30 years, but starting in 1960, they became exposed to bacterial resistance to them within short years, not exceeding five or six years, and this is considered a dangerous indicator. Very exposed patients to bacterial infections that may be fatal.

To take an example of the scale and severity of the problem we are currently facing, in 2010 large numbers of newborns in (Tanzania) were exposed to the risk of death and the cure and survival rate decreased from 70 percent to 20 percent due to Gram-negative bacterial infections. - negative bacteria), according to the study of Kiang and colleagues (Kayange et al. BMC Pediatrics 2010, 10:39) and the reason is that the bacteria develop a type of immunity to antibiotics.

Then, in 2013, the Australian Health Organization sounded the alarm by publishing a report stating that the misuse of antibiotics is the main reason for the emergence of severe and violent resistance of bacteria against antibiotics, and most dangerously, the lack of a new type of antibiotic in production lines that is effective in eliminating Bacteria may take us back to an era before the discovery of antibiotics.

A global response

In the same year 2013, this major catastrophe called on the World Health Organization and the CDC to chart the course of a global action plan that made it clear that 50 percent of antibiotics are unnecessarily dispensed and used in the wrong ways.

In 2014, the World Health Organization issued a global directive to strengthen cooperation in the field of global surveillance and contain this big problem through international cooperation and attention to drug control of antibiotics. The gap is large, currently, in surveillance. In 2015, the World Health Organization requested the formation of international global committees with the participation of a large number of member states of the United Nations Council.

In 2016, 193 countries signed the United Nations Declaration (UN Declaration) to take action on antibacterial resistance, affirming their commitment to the means and bases for their containment, control, legalization and rationalization of use and for their approved medical reasons.

- Causes of bacteria resistance

Causes of bacteria resistance to antibiotics:

> Bad use of antibiotics and excessive use, such as using the wrong drug that does not match the culture of the causative bacteria.

> Until recently, antibiotics were administered without medical supervision or prescription and without a logical medical reason, which leads to their misuse by patients, and this is a major reason for the formation of what is known as antibiotic-resistant bacteria.

> Giving antibiotics to patients as an unnecessary precaution before performing some surgeries.

> Use of all antibiotics medicine to treat viral infections.

> The spread of resistant bacteria in hospitals due to the frequent use of antibiotics in some departments of hospitals.

> The wrong behavior of some patients, which is largely and essential to stop the antibiotic as soon as they feel better and not adhere to the treatment period prescribed by the doctor, which is usually 5, 7, 10, 14 days depending on the type and severity of the disease, so the bacteria become active again and resist this antibiotic.

Antibiotics Control and Control Program

> Dr. Ashraf Amir says that most countries in the world, as well as international organizations concerned with public health and the control of infectious diseases, have approved the antibiotic control and control program. One of the first of those countries is the Kingdom of Saudi Arabia, where there is a very strong system in the field of monitoring, whether in hospitals, medical complexes, or primary health care centers. In the year 1439 AH - 2018 AD, a decision was issued to prevent the dispensing of antibiotics from pharmacies without a prescription, which reflected positively on the health of the citizen and the continued effectiveness of antibiotics on various bacteria.

Among the most important objectives of the program are the following:

- Improving the chances of a quick recovery and avoiding relapses due to bacterial resistance to antibiotics.

- Maintaining the safety and security of those at risk, especially elderly patients, inpatients in intensive care, and those who have multiple health problems and have immunodeficiency.

Rationalizing the use of antibiotics.

Reducing the high cost due to the emergence of resistance, longer hospitalization, and the use of strong antibiotics.

Among the most important tasks of the program are the following:

- Enriching the culture of bacteria resistance to antibiotics, controlling sources of infection, and containing health problems related to early infection without the use of antibiotics.

Use antibiotics only when needed and for specific medical indications.

- When using the antibiotic, it must be ensured that it is the correct and appropriate antibiotic, whether in the dose, quality, or appropriate duration to eliminate the health problem.

The use of recommended doses, which are usually short, non-prolonged doses that are subject to experiments, scientific evidence and medical evidence.

- The culture of the community in dealing with this problem and realizing its seriousness. There are programs to educate the individual, the family and the community towards this problem, and there is also logistical support for all the capabilities these programs need.

Finally, it is very important to differentiate between a bacterial infection, a viral infection, and an allergic infection. Only bacterial infections are for which antibiotics are used. Viral infections, such as upper respiratory infections, from 90% to 95% of them are viral that do not respond to antibiotics and should not be used. In these cases, only occasional treatments are used, and for allergic infections, they are treated with anti-allergic and antihistamines. In some infections such as external ear infections, conjunctivitis or eczema, only topical antibiotics can be used instead of systemic ones.

Therefore, it must be ensured that the antibiotic corresponding to the bacteria culture is used, and there must be reasons for the use of the antibiotic, and that the simple types are used first before reaching the highly developed ones, so that they remain effective and strong for as long as possible. We stress that the overuse and misuse of antibiotics causes very great damage, the most important of which is bacterial resistance to antibiotics.