Book Review | Apocalypse when, asks this brief history of superbugs

The awareness of this problem arrived in India in 2010. A paper published in an international medical journal reported research on an antibiotic resistance conferring gene, New Delhi metallo-beta-lactamase-1 or NDM-1, having named it after capital New Delhi where the scientists identified its origin, leading to questions, accusations and a Parliament debate. The NDM-1 gene was part of a mobile genetic element that can move from one bacterial species to another, from Klebsiella pneumoniae to E. coli, rendering both species XDR (extremely drug resistant) from their status of being MDR (multiple drug resistant). The transportation mechanism was plasmids, but there were other mechanisms, too, namely, phages and transposons.

Yet the challenges didn’t end there. Soon, it was found that the NDM-1 gene had made its way into other bacterial species, like Shigella boydii and Vibrio cholera. What’s more, the city’s water resources were teeming with superbugs, bacteria carrying this resistant gene, among them the Deadly Six which are resistant to 18 antibiotics, including Colistin, the latest. But so was hospital intensive care. Today, up to one half of the patients in Indian ICUs may develop sepsis, a response to infections typically caused by bacteria affecting at least 11 million Indians every year, leading to death.

The root of the problem lies in the fact that sale of antibiotics is unregulated in India, so people self-prescribe antibiotics, often even for viral infections and allergies where they are, by definition, ineffective. Meanwhile, well-intentioned doctors, too, tend to err on the side of caution and overprescribe cheaper, broad spectrum antibiotics. It results in the indiscriminate killing of good bacteria, raising the evolutionary pressure on harmful as well as resistant bacteria to multiply while also turning the patient defenceless against the assault of other infections.

A growing area of concern is also the spread of antibiotic resistance through poultry and livestock which are fattened on a diet of antibiotics.

Rise in temperatures, overpopulation and air pollution as well as poverty aid and abet a rapid rise in disease-producing bacteria, creating a harrowing cycle. With travel and commerce ubiquitous, the world is now sitting on the lip of a new, much deadlier, hidden pandemic when all the bullets in the doctor’s arsenal will cease to work finally and, no new ones having been discovered since 1987, the human race will come close to extinguishing itself. What’s more than shocking is that this apocalypse is only just about a decade away!

A microbiologist by training, the brilliant Anirban Mahapatra goes on to outline some solution ideas in the form of vaccines, phages and AI diagnostics but, clearly, it will take governments and regulatory bodies to come together to devise ways that incentivise their use and lead us away from this catastrophe. A must-read, and not only for science buffs!

When the Drugs Don’t Work

By Anirban Mahapatra

Juggernaut

pp. 288; Rs 599