superbugs - our own nightmare.

Picture the following scene, possibly from a movie, or some TV drama:

"You mean to say, we have created a superbug? It's resistant to everything we've got?" asks the doe-eyed young assistant (or not-so-intelligent colleague, possibly acted by Jessica Alba? She has doey eyes...). Of course, she is stating the obvious that we all have figured out by now, but these films must make its point super-clear, even if it is at the cost of making the "intelligent" female side-kick super stupid, and severely patronising its viewers.

The doctor/professor/researcher has a haunted, melancholy look. "Yes." he says, very simply. The camera zooms in on his brilliant yet troubled face, his haunted eyes... (I'm thinking Eric Bana, but that's only because I like Eric Bana, although I suppose, to be realistic, one must have an actor who is suitably aged. Michael Douglas perhaps fits the bill, is he still acting these days?)

The "superbug" then spreads through the hospital, on to the staff and relatives, and into the community. Amazingly, our heros are not taken ill. The pair work together, in a race against time style of thing. They figure out a solution of some sort, everyone leave the state, perhaps? As they work together, they fall in love (ew, Jessica Alba and Michael Douglas? No way. Who goes well with Eric Bana? I'm a bit behind with Hollywood stars.) However, as they are implementing their solution, one of them reveals that they are also ill with the superbug... In a self-sacrificial manner, this person isolates himself from everyone and dies the painful death. The film is ended - many millions died, but one of our heros survived (which is all that matters in these movies, really), and the bug is contained (this last bit is necessary, otherwise the movie would not be about a superbug but about the apocalypse).

The "superbug" is some sort of science fiction idea, an idea that we can all toy with, an idea that goes well with a comfy seat and popcorn and a night out. But it is actually very real.

Everyone knows antibiotics are wonderful weapon against bacteria. We all know the impact of the discovery of penicillin has had. But few know that bacteria can become 'resistant' to antibiotics. How does this happen? Put simply, in a population of bacteria that can be killed by antibiotics, there may arise some that are resistant to the drug. This resistance can come from gene mutation (which is very rare), or from the bacteria sharing genes with one another (microbiological sex, as my lecturer puts it. He even showed a picture of bacteria-porn.). The susceptible ones are killed off by drug A, but some are left which are resistant to drug A - these ones grow and prosper and make our patient ill. So we use antibiotic B, which, again, kills most, but leaves some resistant ones. We then use drug C, and D, E, F, G... until, hopefully, all has died away. But what if that doesn't happen?

If that doesn't happen, whatever bacteria we are left with, are resistant to drugs A, B, C, D, all the way to G. If we used every single antibiotic we had, and there are still some bacteria left, which continue to populate our patient and make him ill, then we would have our Superbug.

When antibiotics first became available, we didn't appreciate the possibility for resistance to develop. So antibiotics were administered lavishly, indiscrimminately, providing ample opportunity for resistance to develop. And - you guessed it - it developed.

MRSA - Methicillin-resistant Staphylococcus Aureus is one such bacteria (aka "Golden Staph" - I have heard it being called "multi" resistant too). It is resistant to all penicillins, which makes it a very bad thing to have. We have one antibiotic - Vancomycin - which can kill this bug, but this is not used liberally to avoid resistance. Some strains are already showing resistance to Vancomycin (called VRSA), but this is currently rare. MRSA is not uncommon - even endemic - in some hospitals. What happens if VRSA ever reaches such proportions? The situation would resemble the above scenario somewhat - like a movie, but with uglier characters. This is scary. A fellow medical student said that it gave him night sweats (to which we all chuckled nervously... I think he might have been joking.)

What can we do about it?

Health professionals now avoid multi-resistance using many means. One of them involves killing the bacteria as quickly as possible - not giving it time to develop resistance (think maximal dosage and using 2 different types together). Also, we try to give drugs that are as specific to the bacteria as possible, and to limit the usage of very effective drugs that bacteria easily develop resistance against. As you would have figured out by now, the more liberally and carelessly we administer antibiotics, the more likely resistance is. So one very important way to control resistance is to educate the public about antibiotics. Which, I guess, is what this entry is all about.

The crux of it is, antibiotics are not the "solve it all" solution some people believe them to be - particularly for colds and flus (often of viral origin anway). One fellow student joked that at the pharmacy where she works, they have an ongoing joke - "With this drug, you will recover in 48hours. Without it, it will take 2 days". Many people go to doctors, feeling ill, but not wanting to slow down and rest, and demand antibiotics. Our tutor said that in her practice, they had an education campaigne where brochures were printed to educate their patients about resistance - and antibiotic prescriptions went down by 25%.

What else can you do, apart from not demanding antibiotics? Well, for one, don't take someone else's antibiotics. If you are prescribed with them, take them exactly as recommended - don't stop just because symptons have subsided and certainly don't "save some for later". Aside from that, general good sanitation would be good too.

That is all I have on this subject thus far... I feel better now, even if no one reads my blog and I didn't actually end up "educating" anyone.