When medical professionals see patients for the first time, they have already 
made the diagnosis: Patients have already taken ‘over the counter’ antibiotics.

It was the early 90s. I was about eight when one of my favorite cousin sisters “went to god’s home” as I was told. She must have been 15 at that time. I was totally confused. Why should she go to god’s home and never come back? Later on people started telling tales about her disease, maybe a heart disease. Some gave accounts of the pus coming from different parts of her body. I never knew what had actually happened to her.

Few years later, the village tailor died. I never knew him. They said something like sepsis and I thought he got a safety pin stuck on him and bled to death. Two decades later, who knew that I’d be memorizing the signs of sepsis?

There’s a dictum in medicine: send the culture, and give an antibiotic. Culture is growing bacteria in a suitable medium. So it naturally takes few days. That’s why medical professionals prescribe antibiotics according to the symptoms of infection and pattern of bacteria usually responsible and change it if the culture turns out to be different.

We take antibiotic for any infection and the bacterium for which this antibiotic was not meant learns the secret of resistance.
 

These days, when medical professionals see patients for the first time, they have already made the diagnosis. Patients visit with complaints of “tonsillitis,” for example. And they have already taken some ‘over the counter’ antibiotic. It’s so convenient these days. 
There’s a thing called premature aging. But it’s a different kind of aging when you can actually say “gone are the days”. I feel I’m aging, finally.

And there was Darwin with his theory of survival of fittest that doesn’t fit anywhere in the human society. It says whoever is better at procuring nutrition or surviving an environment will live long and reproduce more of his/her own kind. And that will create more of the sturdy, able-to-survive kind of population required for continuing a species or making new ones. Darwin never studied humans, I suppose. 

You don’t necessarily need to be strong or sturdy to go on, or reproduce. It’s all about the money. You have it, or you have nothing. Yes, there’s this thing called education which will teach you the mechanism behind a rocket propulsion before teaching whether to put tomatoes on top or at the bottom of a grocery bag. But that won’t buy you a dime at survival either. 

Educate yourself for the better half of your life expectancy, and you’re still way far from getting a good means of modern-day sustenance. The rat race goes on.

Survival of the fittest
This Darwin guy should still be famous somewhere in the animal kingdom because that’s how it works in the wild. The fastest running deer survives a tiger as it will hunt the slowest running one. But that chase is limited to some nature TV channels for now. Since money is replacing everything that is wild, here’s a wild world that humans haven’t been able to wipe out yet-the microwilderness. 

This is an ongoing battle. Humans started getting the upper hand recently. I wasn’t there in the pre-antibiotic era, thankfully. But when I was small, people were getting killed by bacteria more than by heart disease. I don’t know if these people died exactly due to bacteria, because the norm must have been to blame it on the bug. Just like we blame myocardial infarction for death. Reliable antibiotics were not readily available then and it was easy to blame those reasons.

We are chewing on these very “higher” antibiotics, prescribed or purchased off a vending machine, every week or every month. What a luxury!

Now back to Darwin’s theory, bacteria don’t work that way. They fight. Better the antibiotics, better the fighting. And bacteria can share those fighting secrets among peers. That old school medical one liner suddenly makes sense now: “The only culture some people have is bacterial.” This culture of sharing we try to teach our children. Meanwhile we keep our cell phones locked with complex pass-codes. Everyone has their own, anyway. 

So one bacterium finds the secret punch that disables this antibiotic, and it shares that secret punch trick with another bacterium. Salmonella gets it from Ecoli, Klebsiella gets it from Salmonella, and so on and so forth. These unpronounceables aren’t even related by blood. Heck, they don’t even have blood. These spineless bloodless scoundrels are different species—kind of human and rat. But they share and are well cultured across millions of labs in the world.

It does not work
We take this once-a-day antibiotic for any infection, be it useful or not, and one of these bacteria for which this antibiotic was not meant, learns the secret karate chop called resistance.

Now most of the bugs get replaced by this resistant bug through survival of fittest. It’s the one that lives on and reproduces. And there’s the sharing thing. So there’s resistant Salmonella, resistant E coli, resistant Klebsiella and these “super-bugs” are spreading like wildfire. Nobody even notices. There are so many people in the world. And they are so busy working for money, the only means for sustenance. 

Antibiotics didn’t work. This guy died in Pakistan. And the other one? Can you imagine he ate poorly cooked, poorly handled food from street vendors? Jeez, I always carry my own boiled water bottle. And that fly that just took off from my motorcycle grip? I’ll just wipe that spot off with the cloth that I always have in the corner of my headlamp. There’s no hole in my boat anyway.

That sore throat? I’ll gargle it down. And don’t even mention this slight fever I have. Must have been the hailstorm that I was in yesterday at Baneshwar. Just to be sure I’ll take the three tab antibiotic. Tell me the name again.

The author is Assistant Professor at Maharajgunj Medical Campus, Institute of Medicine

 
• antibiotic
 
• affliction