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Tuesday, September 14, 2010

NDM-1: The Human Side

The reputed medical journal The Lancet Infectious Diseases (August 11, 2010), while reporting about the rapid spread of multidrug-resistant bacteria NDM-1 (New Delhi metallo-beta-lactamase-1) has raised a few concerns—professional, ethical, political and business concerns, and concerns about the very welfare of the humanity.

The emergence of resistant strains to carbapenem drug—a powerful antibiotic that is considered to be one of the last lines of treatment for infections caused by Gram-negative bacteria—is a sad pointer to the indiscriminate use of antibiotics in our country. According to Dr. Abdul Ghafur, Consultant in Infectious Diseases and Clinical Mycology, Apollo Hospitals, Chennai, the inappropriate and indiscriminate usage of antibiotics, as is evidenced by the 60-70% of resistance prevailing in India to extended-spectrum beta-lactamases drugs, as against the 15% in  developed countries, could perhaps be attributed to: one, there is little or no importance given to infectious diseases in the medical curriculum of undergraduate/postgraduate studies, for one can pass these exams even without studying the chapter on infectious diseases and antibiotic usage; and two, there being no restriction on the usage of newer antibiotics with specialist spectrum, pharmaceutical companies could lure practicing physicians to increase the prescription of antibiotics. Cumulatively, it is feared that patients moving across many hospitals in search of a cure are more prone to become “literally walking culture plates of superbugs.” This is certainly an alarming situation that warrants the highest attention of the medical fraternity for immediate correction.

The naming of the superbug after Delhi is, naturally, dubbed by the patriots as atrocious, of course for a valid reason: MRSA infections are a worldwide phenomenon. Indeed, in some quarters, “it is treated as commercially motivated to affect medical tourism in India, which is growing at a rapid rate.” On the other hand, it is claimed that the quality control standards maintained by Indian hospitals are on a par with the best in the world. Incidentally, by 2012, India is expected to become a ‘global health destination’, generating revenue of around $2.2 bn per year. Interestingly, it is expected that during the current year itself, half a million foreign patients will travel to India for medical care, as against 150,000 in 2002. Against this backdrop, no one concerned with the medical profession can take to these comments kindly, for obvious reasons.

Yet, there is a human side to the whole episode. Professor Tim Walsh, the co-author of the article under discussion, created a greater anxiety over the whole issue by raising an apparently simple question, the consequences of which are shocking to think of: “Is this the end of antibiotics?” True, one cannot think of modern medicine without antibiotics for treating infections: with the emergence of multidrug-resistant bacteria and their spread in the communities, deaths due to hospital pneumonia or septicaemia are sure to double. If we lose our ability to treat infections, we may have to even forgo practicing modern medicine, for transplant surgery that warrants the suppression of a patient’s immune system to prevent the body from rejecting a new organ cannot be undertaken, for the patient cannot be left exposed to infections. Similarly, usage of immune-suppressant cancer drugs cannot be prescribed.

The danger of such resistant strains of bacteria changing status soon from a hospital-acquired infection to community-infection—as the resistant gene is carried in the plasmids of the Gram-negative bacteria, it can move from one bacterium to another, including different species—cannot be lost sight of under any pretext. So, maintenance of hygiene, both in the hospitals and in the community, coupled with prudential prescription of antibiotics, becomes imperative. Secondly, to enjoy the prospects of growth under medical tourism, the Indian medical fraternity has to get its act together to prove to the world that India is as concerned about the patient’s welfare as the best hospitals in the world.
– GRK Murty


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