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Ineffective drugs and resistant microbes

The arsenal of medication available to doctors in Kashmir is fast losing its power as microbes are evolving into resistant strains, due to defective health practices like self medication and irrational usage of antibiotics. Ill equipped hospitals of Kashmir have turned into breeding grounds for microbes, making third generation cephalosporins ineffective. Haroon Mirani reports.

Srinagar, March 11, 2006 (Kashmir Newz Specials):

Loosing the arsenal
Loosing the arsenal
Studies at the Sher-i-Kashmir Institute of Medical Sciences (SKIMS) Srinagar, suggest the third generation cephalosporin’s -a class of antibiotics- are fast losing their efficacy in curing diseases.

The findings are a cause of worry for doctors who are losing their arsenal against microbes. At this pace, they say it can lead to a ‘health disaster’.

The first and second generation cephalosporin’s have already lost their efficacy due to the evolution of these microbes. But the speed at which these drugs are being rendered useless has set the alarm bells ringing among the physician community.

Cephalosporin’s are a class of antibiotics (anti-infective agents) used to treat various infections. These are grouped into "generations" by their antimicrobial properties.

The first cephalosporins were designated first generation while later, more extended spectrum cephalosporins were classified as second generation cephalosporin’s. Each newer generation of cephalosporins has significantly greater Gram-negative antimicrobial properties than the preceding generation, in most cases with decreased activity against Gram-positive organisms.

Dr Manzoor Thakur, Infection Control Officer at the SKIMS, who spearheaded some of the studies at the Microbiology Department in the last three years, terms the situation arising out of resistant strains ‘very grim’, and calls for urgent action from the government.

According to studies, common antibiotics which used to be cost effective for poor patients in the past like Ampicillin, Amoxylin, Septron, Cephaloxin, Ciprofloxacin, Ofloxacin, Gentamycin, Cephalaxin, Erythromycin, Chloramphenicol, Cloxacillin, Cefadroxil, Cefachlor, Tetracyclins, Nerfloxacin, Pefloxacin, Sparfloxacin and others used for the treatment of urine, blood, respiratory and other infections caused by E. Coli, Klebsiella, Proteus, Pseudomonas, Pnemococcus, Salmonella, Staphylococcus, Streptococcus have been rendered defunct as a reason of irrational use of antibiotic (i.e., no check on choice, dose and duration of their use).

Pertinently these antibiotics comprise of about 60-70 per cent of life saving drugs.

"Self medication by patients and use of fake drugs are two primary reasons which have helped the microbes to gain their unprecedented resistance" opines Dr Thakur.

Apart from self medication, doctors blame, inadequate dosage and rampant use of these cephalosporins for the problems.

“Antibiotics have no role in viral infections, yet we see cephalosporin’s being used for viral infections like flu and common cold,” says Dr Abid Koka, a surgeon at the SKIMS Hospital.

“Then we see instances of bad and inadequate dosages, irrational use of drugs, which prove counter productive,” says Dr Koka.

One of the striking observations in the study is that the main source of infection and spread of these highly resistant microbes are the hospitals of Kashmir.

Explaining the phenomenon, Dr Thakur says that when patients come to hospitals for treatment, resistant microbes from them infect attendants as well as other patients.

"Lack of sanitation and the procedure controlling the visit of attendants into hospitals gives an unprecedented arena for these microbes to spread their wings," says Dr Thakur.

Hospitals lack proper segregation facilities, which mean infectious patients end up infecting others. Lack of proper sterilisation techniques and waste management in Kashmir hospitals has worsened the situation.

If a surgical instrument needs twenty minutes of sterilisation along with treatment of chemicals, it is given just half of that treatment. Hospitals have thus become meeting points for all sorts of microbes, where they cross breed to produce newer resistant species.

Recently an order circulated to hospitals in the state said that irrational use of Ceftazidime in hospitals has resulted in the emergence of ESBL (Extended Sectrum B Lactamase) producing E. Coli and Klebsiella species, who have rendered the 3rd generation Cephalosporin defunct, thus forcing the doctors to use more costly and advanced multi drug treatment.

Experts say all third generation Cephalosporin's and Carbapenams must be prescribed with utmost caution otherwise resistant strains which emerge out of this antibiotic pressure will be very difficult to treat in near future as they give rise to deadly polymicrobial MDR multisystemic infections in tertiary health care set ups.

“About 60-70 percent of microbes like Klebsiella, E Coli, Staph, Proteus, Pseudomonas, Strep and Salmonella are showing resistance to antibiotics. Newer alternative drugs like Imipenum, Clavilinic acid, Cefepime, Cefpirome, Sulbactam and Aztreonam singly or in combinations are very costly and treatment dose for its specified duration costs a poor patient Rs. 35,000-50,000,” Dr Thakur says.

These newer 30 percent effective drugs are also showing emergence of resistance slowly and at some point doctors fear landing at a dead end where simple infections will be difficult to treat.

Without any concrete and effective health policy the situation continues to deteriorate with every passing day.

There is no check on the quality of drugs as the state comprising of about 11.5 million souls does not have any drug testing facility, which could have stopped the pilferage of fake drugs into the state.

The doctors term the state as one of the highest grossing market for fake companies, all due to lack of any health policy.

These days tuberculosis, diarrhoeal diseases, chest infections, urine and blood infections and other such diseases are on rise. Slowly and steadily deaths due to the infections are on rise.

"We don't have any proper numbers but when microbes gain 70 per cent resistance, the deaths are simply proportionate" says Dr Thakur.

The study warns that if the government and concerned authorities do not take some stringent measures at this hour, hospital infections would soon become the number one killer of people in the state.

"Time is not far away when we will loose 90 per cent of our antibiotics because of our negligence. Twenty years back almost all antibiotics were sensitive and only a few microbes were resistant. But now 70 per cent of microbes are resistant,” Dr Thakur says.

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