These bugs kill 5mn every year, yet doctors have few options to fight them

Shardul Nautiyal, a Mumbai-based journalist, painfully recollects the harrowing sequence of events that unfolded between September 20 and 24. His father, Bhagwati Prasad Nautiyal (72), a well-known botanist, complained of chest pain and was rushed to a reputed hospital in Dehradun. For the next two days, he was in the intensive care unit on respiratory support. He showed a slight recovery. But that was short-lived. Disaster struck on day three. As the family was praying for his safe return home, his lung function deteriorated. It was all over on September 24.Still grief-stricken, Shardul says the doctors told him that his father had a bacterial infection called Acinetobacter baumannii that causes ventilator-associated pneumonia in critically ill patients. “The bacteria caused nosocomial infection that affected the respiratory tract, and other organs. My father could have been saved,” he laments.Nautiyal’s is an ordeal that patients are increasingly facing in India. It could be that a patient is admitted for a heart bypass surgery or a caesarean section, but hospital-acquired infections may take over and prove deadly.Broadly known as antimicrobial resistance (AMR), doctors are grappling with a raft of superbugs like Acinetobacter baumannii that are turning extremely fatal. The big challenge is very few drugs exist to fight such bacterial infections.Mandar Kubal, a specialist in infectious diseases based in Mumbai and founder director at Infectious Diseases and Pulmonary Care, says AMR is very much an established threat in all parts of the world in some form. It negatively affects outcomes in patients seeking healthcare, especially those requiring intensive care.Unlike the coronavirus that came in waves killing more than 7mn people before retreating to a low phase over three years, bacterial infections are understated and show endurance — the traits of seasoned marathoners.So, are bacterial infections the next big lethal adversary for mankind?The silent killerAMR is estimated to kill around 5mn annually, just 2mn short of Covid’s toll, and nobody seems to have taken note. The microscopic organisms survive and grow on their own, quite different from viruses that need hosts, for example, inside human organs like lungs.A large part of the blame goes to the unrestricted consumption of antibiotics and the lack of awareness about the invisible dangers it can cause.The scientific world is desperate, grappling for solutions that thwart bacteria. But so far, they have met with little success. Compared with more than 1,300 anti-cancer drugs that were in clinical trials in 2020, only 27 were for antibiotic drugs.A quick check shows a startling number of people who have taken antibiotic drugs without a doctor’s prescription, but their cough or chest congestion persisted. A calamity comes a step closer each time those yellow, red, pink or blue capsules are taken without a doctor’s advice.The surge in sales of antibiotics in India proves that point. medium115655846Augmentin, a brand that was prescribed selectively until a decade ago, is the top-selling drug in India with annual sales of ₹843 crore. The total market for anti-infectives in India stands at ₹25,682 crore at present, growing steadily from ₹18,936 crore in 2020, according to data from PharmaTrac, a data analytics firm that tracks prescriptions in India.According to a medical expert, it may not be inaccurate to assume that at least 25% of those do not work on patients, but he said there are no such studies that he is aware of. medium115655874There are some issues related to the diagnosis of bacterial infections. “If a doctor sends a patient to do a test for a common cough, will the patient even take that advice?” Kubal says, pointing to the additional costs for such bacterial culture tests.The World Antimicrobial Awareness Week from November 18 to 24 aims to tackle the burgeoning spread of bacterial infections. The effort of the global health community led by the World Health Organisation (WHO) is to spread awareness of handling antibiotics, antivirals, antifungals and antiparasitic drugs with utmost responsibility.Here are a few essential pointers to tell the whole story. medium115655897What was easily treatable two decades ago with amoxicillin or azithromycin now needs stronger combination drugs like Augmentin or Clavam, drugs that have amoxycillin and clavulanic acid. There are superbugs or infections that are now resistant to even carbapenems, one of the last sets of drugs. medium115655939A 2022 study by the Indian Council of Medical Research, the country’s apex medical research body, says resistance to carbapenems in Acinetobacter baumannii was recorded as 87.8%, limiting the availability of treatment options. medium115655969AMR is seeing a disproportionate share in deaths from low- and middle-income countries. medium115656001 medium115656014The WHO sees AMR as one of the 10 leading global threats to humanity. The others are Ebola, pollution, HIV, dengue and influenza. medium115656047In September, global leaders committed to a decisive action plan on AMR.Kubal says the solution needs to be found at critical stages. He says those include surveillance for multi-drug-resistant organisms, especially carbapenemase-producing bugs, using faster turnaround time for molecular biology tests to detect resistant genes, appropriate transmission precautions, proper and adequate antimicrobial therapy, proper disinfection and infection control in facilities are a few important factors to address. medium115656076With the risks getting bigger, the WHO has put in place a guidebook called AWaRE (access, watch, reserve) for doctors and healthcare systems, which educates and classifies on the appropriate use of antibiotic drugs and reduces them where not needed. medium115656099There are more factors at play. Medical experts like Kubal are worried about the impact that climate change has on tackling the superbugs challenge. He says scientific studies show with every additional 1°C rise in average air temperature, there is a 14% increase in the proportion of carbapenamse-producing Klebsiella pneumonia. medium115656115Clearly, the superbugs are winning. In 1945, Alexander Fleming, who discovered penicillin, the drug that saved the world, had presciently warned that overuse of the drug may lead to bacterial resistance. His wise words fell on deaf ears.Graphics by Sadhana Saxena