Drug resistance threatens core of healthcare

Emmanuelle Ingabire, from Kabgayi, was still in agony, suffering excruciating pain, her temperature at a burning level. She was vomiting and has general body weakness. All these were three days after she had completed her third course of treatment for a bout of malaria. “It must be witchcraft,” said Ingabire’s neighbours as they looked at the emaciated young woman who was wasting away rather too fast. The strong smell of drugs wafting from her room would have made many a pharmacy downtown envious, yet Ingabire felt worse than ever. You can hardly blame her for despairing. Luckily for her, a younger brother in Kigali funded a visit to one of the private hospitals in the city where she was diagnosed with a drug-resistant strain of malaria. The previous courses of medication had proved ineffective because the particular strain of malaria she was suffering from was resistant to the drugs she had been given. A different course of medication was prescribed and Ingabire was back on her feet in a few days. Twenty-year-old Ingabire’s case is not as unique as it may seem. Studies indicate that several infections have evolved to be resistant toward drugs.A 2012 report by the World Health Organisation indicated that there were about 450,000 new cases of multidrug-resistant tuberculosis that year, most of them in sub-Saharan Africa. The same report indicates that even the most common infection–influenza (flu)–has evolved to be resistant to drugs normally used to treat it and humans are facing new symptoms from the airborne infection. Similarly, a 2011 study published by the Journal of Tropical Medicine and Hygiene showed 16.3 per cent generated resistance to antibiotics in urinary tract infections. And, last month, a new WHO survey showed that antimicrobial resistance in bacteria (the main focus of the report), fungi, viruses and parasites is an increasingly serious threat in every part of the world. “A problem so serious that it threatens the achievements of modern medicine,” WHO said. “A post-antibiotic era, in which common infections and minor injuries can kill, far from being an apocalyptic fantasy, is instead a real possibility for the 21st century.” This terrifying trend has caused alarm in medical circles as medics wonder how they will help their patients as drug-resistant strains make more and more drugs powerless to treat common infections. What causes drug resistance? According to Dr Olivier Manzi Mulisa, an infectionologist at Central University Teaching Hospital of Kigali, drug resistance generally arises from auto medication. Auto medication occurs when individuals lack the slightest idea on which medicine is fit to treat a certain illness but insist on buying medicine from drug shops without clear medical procedures such as diagnosis. “Cefuroxime, methonidazole are among the antibiotics we commonly administer to the patients. Our patients can read this information on the prescription notes, and the next time they experience a problem, they just mention out these names to the people behind the counters in drug shops,” Dr Mulisa says. “For example, coughing can be a symptom of many diseases such as pneumonia or tuberculosis yet a patient may choose self-medication with amoxyline.” One is also at a risk of getting a resistant infection if you get exposure to microorganism from an infected person currently undergoing medication. This happens when a disease causing organism has had prior treatment. When we go to drug shops, we are not always sure whether the person behind the counter is qualified for the job. Cash-on-delivery as the mode of exchange is and there is nothing absolutely to worry about at that moment. No one can differentiate between a professional health worker and a gambler in the village setting. But the poor prescriptions will not know your innocence; the drug will not help your ailment in case of prescribed overdose or wrong medicine for the infection. As it is, the right approach to an infection would be attending a health facility first while failure to obtain adequate tests will complicate your condition. Effect of taking drugs irregularly Emmanuel Rucimbano, a TB patient, remembers how it turned out for worse when he stuttered with drugs. “I suddenly started experiencing the night sweats, the cold chills and the sputum was finally reappearing. Almost similar to my previous attacks, I could see blood spots after coughing. This was the least of my expectations after completing eight months of treatment. I thought it was all gone. Four months later, and my intuitions were right but I was not yet free of tuberculosis,” Rucimbano says. Dr Mulisa says rrregular taking of drugs may also cause microbial resistance towards drugs to develop. He cites diseases like tuberculosis that are highly sensitive toward irregularities and whose retreatment is more cumbersome. “When treating tuberculosis, a combination of rifampcin, iozonia, ethanobutanol and streptomcycin are used. After exposing the body to these drugs for six months, resistance may develop even on completion of the dosage. The microorganisms may persist in the body with much vigour than before,” Dr Mulisa says. “Phasing out these resistant microbes requires another twist of approach and in the case of TB, retreatment takes up to 20 months with a much stronger dosage than before. The new medication is an amalgamation of drugs and intravenous administration.” Resistance to drugs is also common in urinary tract infections and a 2014 report by WHO. Dr Mulisa says nosocomial infections have acquired a lot of resistance in hospital environments. Among these are germs that cause urinary tract infections. There is no gain without pain as once one drug fails to treat a certain infection, the recommended drug is usually stronger and costly. Also some of these strong drugs are rare on the market. Preventing drug resistance “Although they are useful, antibiotics can be the deadliest chemicals to human beings. In case a naïve patient uses a bacterial antibiotic to cure viral infections such as a cold, cough, the infection will not cure. “Instead, the medication will obviously result into inherent bacteria getting acquainted to the medication such that on reappearance, the medication won’t have any effect. People should understand that there is indeed a big difference between viral infections and microbial infections,” adds Dr Mulisa.

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Drug resistance threatens core of healthcare