Lack of first-line antibiotics

Treatment of bacterial infections is becoming a serious problem globally. Bacteria are developing resistance to antibacterial drugs. In Pakistan, it is assuming alarming dimensions. There are many causes for the bacteria developing resistance to anti-bacterial drugs. One cause is not using the first line anti-bacterial for treatment of common infections, due to non-availability of many first line essential lifesaving anti-bacterial drugs. Consequently, the utilisation of second and third line anti-bacterials for treating common infections creates bacterial resistance leading to life threatening difficult-to-treat infections caused by these resistant organisms.

The first line essential antibiotic penicillin V, which is universally recommended for treating common respiratory and skin infections, has not been available for decades. Recently erythromycin, another first-line antibiotic meant for treating common infections, has also disappeared from the market, thereby leading to further increase in the use of second-and third-line antibacterial drugs compounding the problem further.

For treating common urinary tract infections, nitro furatoin is an affordable first-line effective essential anti-bacterial drug. It has also not been available for decades, resulting in misuse of second-and third-line antibacterial agents to treat urinary tract infections, thus further aggravating the problem of bacterial resistance.

Many bacteria have now become resistant even to second-line antibacterial drugs, necessitating the use of third-line anti-bacterials which are also losing their efficacy.

As an example, in the earlier days, typhoid fever which was easily treated with anti-bacterials like chloramphenical, amoxicillin/ampicillin, cotrimoxazole and furoxone, costing a few rupees, for the treatment of one patient. Owing to their misuse, these anti-bacterials lost their efficacy, with the result that the quinolone group of anti-bacterials costing hundreds of rupees to treat one patient had to be used.

Now with widespread misuse of quinolones for treating ordinary infections, typhoid bacilli like other bacteria are developing resistance to quinolones, needing prolonged courses of treatment and many a time requiring the use of third generation parenteral cephalosporins that cost thousands of rupees for treating a single patient.

The World Health Organisation recommended that essential drugs are available all over the world, including in Saarc countries with the sole exception of Pakistan.

The availability of essential drugs including lifesaving anti-bacterials are a must for safeguarding people’s health and lives.

Our government has not only pledged to the World Health Organisation to make essential drugs available but is also constitutionally bound to provide these to its people. Yet the government is least bothered about the health and welfare of the people.

On the contrary, drugs that are not registered in the US, the UK, Australia, New Zealand and Scandinavia and even the harmful banned drugs in other countries are registered in Pakistan and are flooding the market. Companies making unethical and unsubstantiated promotional claims are allowed by the health ministry with the sole motive of making illegitimate financial gains, thus robbing the health of the people. Furthermore, fake and expired drugs are sold unchecked.

MUHAMMAD MAAZ NASIM

Karachi