MOST Guyanese know of antibiotics. Many persons go to the pharmacy and purchase antibiotics at the first sign of a runny nose; some people do not even know, or care, what type of antibiotic they buy. Others demand that doctors prescribe antibiotics for diarrhoea, skin rashes, and every illness in between. Many doctors – just to get rid of a nagging patient – just give in and write a prescription. This reality is not unique to Guyana, it happens worldwide. Unfortunately, this overuse and abuse of antibiotics will probably cause one of the greatest medical disasters in modern history, unless we work to avert it.

Antibiotics kill bacteria, and are among a class of drugs called antimicrobials. These drugs work by killing the germs that cause disease. Humans have not always had access to antibiotics. The era of antibiotics began in the 1940s with an accidental discovery in 1928 by Alexander Fleming, Professor of Bacteriology at St. Mary’s Hospital in London. That discovery lead to the isolation of penicillin, the first widely used antibiotic. Before this era, doctors had nothing with which to fight common infections. As a result, people usually died of infections which are routinely cured today. For example, the death rate from bacterial pneumonia was 35 per cent, and bacterial meningitis was almost always fatal. Presently, almost no one dies from bacterial pneumonia, and meningitis – and many other diseases – are routinely cured by correctly used antibiotics.

After the discovery of the first antibiotic, many new ones were discovered. Those “wonder drugs” became widely manufactured and used in the five decades after 1940; so popular and effective were they, that Surgeon General William H. Stewart told Congress in 1969 that it was time to “close the book on infectious diseases, to declare the war against pestilence won.” Sadly, he was wrong; the germs have adapted and learned how to beat antibiotics.

All living things adapt to survive. With the extensive use of antibiotics, bacteria have adapted in various ways. Some of them have learned how to make chemicals that destroy antibiotics, making them ineffective. Some bacteria are resistant to one or two antibiotics, yet others are resistant to all known antibiotics — these are called superbugs. Doctors call this anti-microbial resistance (AMR). This change is an extremely worrisome development. Unfortunately, humans are ourselves largely to blame.

Antibiotics are antimicrobials that affect only bacteria; they should therefore be prescribed only for the treatment of bacterial diseases. Flu, colds, and up to 60 per cent of diarrhoeal diseases are caused by viruses; antibiotics are therefore ineffective. But if a patient has, for example, a cold and uses an antibiotic, any bacteria in that patient’s system could become resistant. Patients who do not completely use all the antibiotics prescribed by a doctor can also encourage bacteria in their bodies to develop resistance. The result is, that if that resistant bacteria infects another person, that particular class of antibiotics may not work. If the infected person survives long enough, a doctor may have to prescribe a more expensive drug, or one that may harm the patient.

Another concern is the use of antibiotics in livestock to promote growth. That practice can result in the production of resistant types of diseases which can cross over to humans, who would be powerless to treat them.

One answer to the problem may be to produce new antibiotics. Unfortunately, this is not easy to do. It costs a lot of money and time to produce a new antibiotic. According to the World Health Organisation (WHO) only two new classes of antibiotics have been found in the last 15 years. Additionally, drug companies do not make large profits from antibiotics, so, companies just don’t bother. The result of the rapid advance of drug-resistant germs and slow rate of development of new drugs is clear: we could go back to the days when we have no effective ways to treat common infections.

A 2014 WHO report stated that, “This serious threat is no longer a prediction for the future, it is happening right now in every region of the world and has the potential to affect anyone, of any age, in any country. Antibiotic resistance—when bacteria change so antibiotics no longer work in people who need them to treat infections—is now a major threat to public health. The WHO stated too, that inappropriate use of antibiotics in animal husbandry is a major contributor to the emergence and spread of antibiotic-resistant germs, and that the use of antibiotics as growth promoters in animal feeds should be restricted.

Considering the seriousness of the threat to the human species, a global action plan was endorsed at the Sixty-eighth World Health Assembly in May, 2015. World Antibiotic Awareness Week is now held every November; and the Food and Agriculture Organisation of the United Nations (FAO), the WHO, and the World Organisation for Animal Health (OIE) have all issued calls for nations to use antibiotics responsibly.

On an individual level, we must recognise the value of antibiotics. Citizens and health care professionals must commit to actions that will ensure that this valuable resource is available for future generations. And we must resist the urge to misuse and abuse antibiotics, because if we continue to do so, we will go back to the dark days of the pre-antibiotic era.