A South Asian Perspective to ‘Myths and Misconceptions around Antibiotic Resistance: Time to Get Rid of Them’

Dear Editor:

I have read the article by Amábile-Cuevas [1] with great interest. It is very impressive as the author has presented a very detailed overview of the subject of antibiotics resistance and highlighted the need of Antimicrobial Stewardship Program (ASP) in the healthcare systems worldwide. While it is true that majority of the private pharmaceutical productions are carried out in human resource extensive areas like low- and middle-income countries, the fact remains that the health care system in those countries is surviving albeit barely, upon the provision of generically produced medications including antibiotics. The federal and state funded hospitals take care of majority of patient load and patients admitted there will have access to only the hospital formulary drugs which often will be an economically feasible generic medication. The emergence of super bugs havoc in India and Pakistan since 2017 while may very well be attributed to introduction of active antibiotics metabolites in water bodies and increased use of antibiotics in the veterinarian realm, a huge chunk of multi drug resistant organisms (MDRO) outbreaks is a direct consequence of an absence of prescription-controlled distribution of antibiotics. Majority of antibiotics including tetracyclines, macrolides and fluroquinolones can be purchased as an over-the-counter drug. This lack of prescription control has left physicians to deal with the wards full of patients sick with typhoid and their pathogens being resistant technically all the antibiotics in the formulary as I observed during my medical school training. The authors have referenced a recent study by Booth et al. [2] which interestingly correlated the issues of sanitation, corruption, and healthcare access in middle income countries with increased fluroquinolones resistance in Escherichia coli. Persons with non-medical backgrounds might be surprised by the stated fact that usage of generic antibiotics might be contributing to resistance. In a world where big pharmaceutical companies have incentivized the use of their products in every way, it will be harder to imagine that the generic drugs can somehow be pharmacologically inferior to commercially advertised products. It is safe to suppose that an ideal first step to help with this antibiotics crisis in South Asia would be strong implementation of antibiotics prescription and distribution laws.