Sunita (assumed name *) was in the hospital for a long time. Diagnosed with cancer, she had undergone multiple rounds of chemotherapy. As a result, her immune system was severely stressed. A few weeks later, she developed an open chest wound that had to be operated upon. Soon after, her doctor noticed a stubborn bacterial infection that just would not go away, no matter what antibiotics they prescribed.

The doctor conducted a few tests and found that Sunita was infected with Methycillin-resistant Staphylococcus aureus or MRSA, a fatal drug-resistant bacterium that thrives in hospital wards all over the world (www.mayoclinic.com/health/mrsa/DS00735). This bacterium is believed to be widespread in Bangalore hospitals as well, according to doctors affiliated with eight major hospitals in the city. Patients who have been in the hospital for longer periods are the ones susceptible to the bacterium, say the doctors to whom this reporter spoke to.

The MRSA bacterium is just one symptom of the larger antibiotic resistance pandemic. As doctors over-prescribe and patients abuse antibiotics, bacteria gain immunity to existing treatment plans.

Inside the HOSMAT Hospital, Magrath Road, Bangalore. Pic courtesy: HOSMAT.

"Antibiotic resistance is a silent killer and must be tackled (on a war footing) like HIV and climate change,” says Dr Sunil Chandy, at Christian Medical College and Hospital, Vellore, who is conducting a collaborative study with the World Health Organization (WHO) on the emergence of antibiotic resistance in Vellore, Tamil Nadu. His research, published recently in Tropical Medicine and International Health, found that resistance to most antimicrobials is high in both urban and rural India, and the high level of resistance is probably due to unnecessary use of antibiotics.

The misuse of antibiotics

When a patient from the low-income strata goes to the doctor, he needs a quick fix, as he is not in a position to go in for elaborate tests. Doctors are willing to prescribe appropriate medication following proper tests, but as the patient must quickly return to work to support his family, the doctor could land up prescribing a strong antibiotic such as methycillin for an illness that probably is not caused by a bacterium.

Most fevers are viral and no medicine can fight viral infections; the body's immune system is the only defense against the disease. But when a patient demands medicine, doctors fold and prescribe antibiotics for their placebo effect. Dr Bansal at Rajarajeshwari medical center on Mysore Road admitted to this, echoing the sentiments of others of his kin.

In several hospitals surveyed (names withheld, see box) that serve low-income groups, antibiotics are prescribed without first testing for the presence of bacteria. As a result of over-prescription by doctors and pharmacists, every antibiotic coming to the market today becomes ineffective in a few months, says Dr K S Ranjunath, Head of Orthopedics at Bowring Hospital, Bangalore. He stresses the need for a government policy that regulates prescription of drugs.

As antibiotics enter the blood stream, they attack the invading bacteria. In the fight for their lives, the bacteria must evolve or die. Sometimes they evolve to become multi-resistants, informally known as ‘superbugs’ that can resist the drug. The patient then finds him/ herself in the clutch of a disease that was treatable even a few years ago. Sunita was unable to fight an infection that might easily have been cured in its original form.

Antibiotics are useful to combat only bacterial infections and must be prescribed for a specific number of days. The most common mistake made is to stop taking the drug as soon as one feels better, leaving the course of antibiotics unfinished. A course shorter than needed will help in the evolution of superbugs, according to Dr Sujith Chandy.

Victoria Hospital, now renamed Bangalore Medical College and Research Institute, near the Bangalore Fort at K R Road. Pic: Wikipedia.

The misuse of antibiotics, whether by doctor or patient, all doctors agree, is the root cause of the problem. There is an “indiscriminate issue of antibiotics” says Dr Ranjunath, among others, “you give Rs.10 to the pharmacist, and he will give you two (antibiotic) tablets (for even the common cold).” This illustrates a point made by Dr Chandy and others, that out of all the cases for which antibiotics are prescribed for in India, only 30 percent are bacterial infections.

Gayathri Vaidyanathan is currently pursuing her masters in journalism from Columbia University (New York). Research for this story was done when the author was pursuing journalism at the Indian Institute of Journalism & New Media. Supriya Khandekar, staff journalist, contributed additional reporting.

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