India and the politics of superbugs

| July 26, 2015 | 0 Comments

A study on the presence of a superbug in Indian hospitals has evoked cries of conspiracy from sections of the medical fraternity. Others say we should take the threat seriously. An expert brings perspective

P M Bhargava

India has been at the receiving end of superbugs despite the chances of a superbug evolving in India being very small. A multi-drug resistant superbug emerges because of indiscriminate and unscientific use of antibiotics, and it takes a certain density of modern antibiotics-using population across the country for a superbug to evolve. India just doesnt have this. More than 80% of India’s population do not have access to modern medicine and cannot afford antibiotics.

Despite the fact that the developed Western world was the birthplace of the multi-drug resistant (MDR) bacteria, people still go there for specialized treatment, and no scientific journal has opposed it. Further, MRSA (Methicillin-resistant Staphylococcus aureus) is not called US-MRSA! Therefore, naming the recent superbug reported in Lancet, after New Delhi, and advising patients not to come to India for treatment, is scientifically absurd, socially hilarious and politically discriminatory. We should also recognize that some types of multi-drug resistance (like the one in the superbug named after Delhi) are known to be caused by plasmids which are free-floating pieces of DNA that can cross the species barrier. Plasmids do not respect borders and it is likely that the Lancet superbug originated in the UK. We would, therefore, be fully justified in giving it another name. How about UKOLI?

But, let us not forget our responsibility as a scientifically developed country. The need today is to discover new antibiotics. But, less than 1.6% of the R&D budget of the world’s top 15 pharma companies is spent on discovering new antibiotics. India can take the lead, using traditional approaches. Haldi (turmeric) has been used since time immemorial; besides we have over 40,000 plant-based drug formulations using some 10,000 documented plants. They can be scanned for possible leads.

Another approach will be to look at peptides—small proteins consisting less than 50 amino acids that are building blocks of protein. Penicillin discoverer Alexander Fleming also discovered the first antimicrobial protein-/peptide, lysozyme. The second, highly potent antimicrobial peptide, seminalplasmin, was discovered by us in Hyderabad and reported in two papers in Nature in the 1970s. An analogue of a part of seminalplasmin that was synthesized by R Nagaraj and his colleagues at the Centre for Cellular and Molecular Biology, Hyderabad was shown to be an even more potent antibacterial agent than the parent protein, seminalplasmin; this analogue is now marketed by Bachem, the world’s largest peptides’ manufacturer. In fact, today there are probably more than 1,000 antimicrobial peptides known, but none commercialized. This is another gold mine that India can dig into. To prevent the emergence of a dangerous superbug in India, we also need a national antibiotic policy to be followed by all hospitals and medical practitioners.

What the medical profession did not realize when the age of antibiotics dawned after World War-II is that bacteria can mutate (undergo random genetic change which, at times, can make it resistant to a particular antibiotic). Thus, if we take a culture of an antibioticsusceptible bacterium in which we have one randomly arising drug-resistant mutant and allow the culture to grow, normally the ratio of antibioticsusceptible to antibiotic resistant bacteria will continue to be 1 million to 1. However, if we expose the culture to the particular antibiotic, the million susceptible bacteria will die but the one resistant bacterium will survive and now multiply happily without any competition. In course of time, the culture would have a million only drugresistant bacteria, precisely what happened around the world on account of indiscriminate and uncontrolled use of antibiotics.

We now have bacteria resistant to one or more antibiotics. If a bacterium becomes resistant to say 159 out of 160 antibiotics in use, and the one to which it is susceptible can only be given under strict medical supervision, we have a superbug. This happened in the US in the 1990s when MRSA evolved.

India and the politics of superbugs. P.M. Bhargava. The Times of India (Chennai, Bangalore), 17th August 2010.

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