Targeting Ground Zero

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Maneshwar Dixit is pursuing his Masters in  Biochemistry at the University of Delhi. He was selected for the NGS Internship Program this Summer 2019. Maneshwar interned with Dr. Souvik Bhattacharjee at the Special Center for Molecular Medicine, Jawaharlal Nehru University. During his time there, he worked on understanding artemisinin-resistant malaria. In this article, he highlights the urgent need for awareness on drug resistance.


 

“Rajpal is well known to his fellow villagers because of his severe lung tuberculosis (TB). He is 38 and has a wife and two kids. In Rajpal’s case, the cause of his TB is genetic as it was inherited from his father. The condition of his disease was not as severe in the early days, recalls his wife. It became worse after the birth of their first child. Rajpal was put on medication from a private clinic but the cost of medication was higher than what the family could afford. Due to this, he did not take the prescribed amount of medication. He could only afford to take it thrice a week, according to his wife. Furthermore, Rajpal used to reduce the dosage of the drug to elongate the duration i.e., instead of taking 2 tablets a day, he would take 1 tablet a day, assuming that increasing the length of medication would clear his TB. This is a common myth in most villages. His poverty, lack of awareness, underachievement of government schemes, and poor implementation strategies led to the development of drug resistance and severity of his TB. Now, his life is at risk.”

       This is just a single story. Similar to drug-resistant TB, artemisinin-resistant malaria is spreading in Southeast Asia. Our hospitals receive a large number of patients who show drug resistance, indicating an urgent need for interventional measures.

  • What is drug resistance and what causes it?

    Drug resistance is the reduction in effectiveness of a medication such as an antimicrobial in treating a disease or condition. There are many factors that could contribute to this, most prominently:

    1. In the case of antibiotics, because of frequent and widespread use, bacteria adapt and change, making the drugs less effective. The more antibiotics are used, the more resistant the bacteria can become as sensitive bacteria are killed while stronger ones resist the treatment, grow and multiply.
    2. The use of antibiotics in viral infections even when they are not needed.

Artemisinin is a widely used drug to treat malaria, isolated from the plant Artemisia annua or sweet wormwood. The World Health Organization (WHO) recommends Artemisinin-based combination therapies [ACTs] as the first- and second-line treatment for uncomplicated P. falciparum malaria as well as for Chloroquine-resistant P. vivax malaria.

In ACT, two drugs are used. One to reduce the parasites (decrease in parasite biomass) and a partner drug to eliminate the remaining parasites (cure). Factors responsible for the spread of these parasites include: poor treatment practices, inadequate patient adherence to prescribed antimalarial regimens, widespread availability of oral artemisinin-based monotherapies and substandard forms of the drug.

  • Why should one be concerned?

       As resistance development directly causes treatment failure, this will result in a serious public health threat. Treatment failure will also increase the cost of treatment and will slow down the development of the economy. Causes including myths in rural regions about the use of drugs and antibiotics as a panacea, financial constraints, people self-medicating without consulting qualified professionals, are all factors which need to be tackled at ground zero. Otherwise, we will find ourselves unprepared against most diseases.

  • What should be done?
  1. Awareness must be produced in remote village areas and among pharmacists regarding the use of antibiotics.
  2. Antibiotics should not be against viral infections.
  3. One should complete the prescribed course of treatment exactly as instructed by the heath care provider. One should not stop taking medication even if one feels better or save antibiotics for future use.
  4. Medication from another person must not be taken because different kinds of drugs treat different types of infection.
  5. In 2017, malaria took 404, 500 lives in the African region. The most urgent challenges are to strengthen pharmaceutical market regulation.
  6. Long-term political commitment to work for the removal of substandard medicines from markets around the world once and for all.

    References:

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