Persistent whenever holidaying in India. On many

Persistent sneezing. Body aches, and congestion. Fevers even!Common symptoms I experienced as a young kid whenever holidaying in India. On many occasions, I would be advised, even encouraged, to have some antibiotics to get me all better quickly. Still, mum would always exclaim: “Unnecessary!” I wondered where these conflicting ideologies came from. Surely, medicine would help?  Well, this is exactly how I came to learn of antibiotics. Knowledge (and consequences) of these ‘magical medicines’ quickly became apparent to me. It was simple. Everything comes with a price! A threat we once thought to be a concern of the future, is slowly but surely dawning upon us to be a very real global health threat.1 I am talking about none other than antibiotic resistance (AMR).  On a more serious note : We may be on the verge of entering a post-antibiotic era.2 It is terrifying to think that we may have to return to living like we did in the dark ages. So, how did we get to this point?  Fleming’s discovery of Penicillin heralded the ‘Golden Age’ of Antibiotics.3 With it, eventually came effective treatment for infections like scarlet fever, pneumonia, and STI’s; ones that were previously often fatal.4 However, this ‘Golden Age’ was bound to, one day come to an end. Bacteria, like any living organism, abides by evolution –meaning inherent determination drives the fittest to survive. Thence, acquiring resistance was inevitable.10 And this is precisely the issue.  After extensive research, I found an article that hit quite close to home: A disconcerting New York Times report, written by Gardiner Harris, detailing a deadly epidemic of antibiotic resistant superbugs’ claiming the lives of tens of thousands of newborn babies in India, solely because of antibiotic ineffectiveness.14  It was upon reading this article that I realized all what unsettled me about the prospect of AMR persistence.  Firstly, AMR’s ubiquity is evidently affecting the next generation, the one irrefutable thing I know is that future generations should not have to bear the cost of our errors. The article talks of over 58,000 newborn baby mortalities as a direct result of antibiotic resistant bacterial infections;14 but in my mind, these were 58,000 preventable deaths of completely innocent victims thus making it all the more harrowing. Add that with Harris’s upsetting recount of Ms. Thakur’s seemingly healthy premature baby’s untimely death14, and all I can think of is that we really have messed up this time.  Newborns are vulnerable. It is our responsibility to ensure that they are given the best possible environment to grow up in. As I see it, we are not doing a very good job. We have created a dangerous biome of life-threatening bacteria through years of mindlessly overusing and misusing antibiotics. From inappropriate prescriptions to weak surveillance of antibiotic consumption and supply, we have turned a blind eye towards the situation.13 The fact that “almost every baby born in Haryana, India… was injected with antibiotics”14 regardless of need shows just how irresponsible we have been.13 The individual person is also equally at fault. We have grown accustomed to consuming and expecting antibiotics as cures, even when unnecessary. We have not even left the animals alone! “Over 50% of antibiotics in USA are used solely for agriculture Lodato et al., 201313 Simply put, we have been ignorant and rapacious. Money, like always, has been a key player. Pharmaceutical companies don’t see monetary gain in researching for effective antibiotics13,Fig.2 yet existing ones are still freely sold in some countries for cheap profiteering. With that, the Indian government “stopped some studies in fear of negative publicity jeopardizing its profitable medical tourism industry”.14 It irks me because it is obvious that even at such a critical point, money is still more important than a human life. But I am most unsettled by our delayed response. Why has it taken us so long to do something? When the magnitude of its consequences and inevitability of it all was postulated by Fleming himself, why were we (as a species) so careless?10 I believe optimism bias is at play. The majority of us have a tendency to believe that we are excluded from whatever is happening in the world, that somehow we are different and what is affecting ‘them’ would not affect us.5 But this is reckless thinking. We can so easily blame India by proclaiming it is a country where “half the population defecate outdoors” and “sewage generated is untreated” Harris, Dec. 2013; but it is this sanitation crisis coupled with its unimaginably large population that creates the ideal hub for bacteria to migrate across the globe.14 This means that AMR is not just a problem for developing countries like India to solve but one that necessitates global cooperation and efforts for results. If we fail, AMR persistence really would affect and change life as we know it – and this really is worrying.  Even today, as many as 732million people in India have no direct access to a toilet, thus many resort to releasing themselves out in the open. It is unfortunate that people today still have to live like that. Harris mentions bacteria resistant to most antibiotics is already found in “India’s water, sewage, animals, and mothers”.14 I think this is a very dangerous cycle to live within: living in unsanitary conditions lead to more bacterial infections, and to combat them more antibiotics are needed, further resulting in more resistant bacteria. From fig.3 we can see that there has been a significant increase in India’s antibiotic consumption from 2000-2010.Fig.3 But it is not just the environment, the article alludes to crowding, insanitation, and underfunding in Indian hospitals as reasons for this worrying spread of AMR. Makes sense, any hospital where 2 to 3 patients are sharing a bed, there is no running water, or soap, is bound to drive the spread of bacterial infections.14 

With that, AMR is threatening the very nature of modern medicine. Procedures like hip replacements, heart surgeries, and caesarean sections, ones that are routinely carried out may soon become too dangerous to conduct.15 That coupled with spread nosocomial infections ultimately means that treatable infections are slowly becoming life threatening.13 

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