INTENSIVE-CARE patients in South African hospitals are increasingly given the wrong type of antibiotic - which in turn is fuelling the spread of lethal superbugs.
The UK's most senior medical adviser last week called for superbugs to be classified on the country's national risk register for civil emergencies with other hazards such as terrorist attacks and coastal flooding.
An audit commissioned by the Critical Care Society of South Africa involving 248 intensive care unit patients, published in the SA Medical Journal last year, highlighted the urgent need to monitor antibiotic use in South Africa.
Professor Fathima Paruk, director of the university's cardio-thoracic ICU and lead author of the survey, said the results confirmed widespread fears of the abuse of antibiotic drugs. "We have reached a crisis point because there are times when some of the bugs that we isolate from our patients are resistant to most, if not all, available antibiotics.
" Drastic measures are necessary to curtail the irrational use of antibiotics ... We believe that it is ethically justifiable to consider the restricted use of antibiotics and the application of punitive measures for those failing to comply."
The survey of patients in every adult and paediatric ICU ward - both public and private - in South Africa found that more than half had not only received the wrong drugs, but they had been used incorrectly.
This week the Sunday Times found that:
Health authorities have raised the alarm about new superbugs, including relatively harmless bacteria that become lethal after coming into contact with an enzyme called NDM-1;
NDM-1 was linked to four hospital deaths in Gauteng last year and other patients were found to have it;
Other superbugs on the increase include Clostridium difficile, which attacks the stomach. It kills about 14000 people annually in the US;
Health professionals have warned of the emergence of total drug-resistant tuberculosis (TDR-TB), another superbug that has been likened to "airborne cancer"; and
Faced with a potentially disastrous outbreak of drug-resistant TB, the Medicines Control Council has authorised the use of a controversial drug yet to be officially registered in South Africa - bedaquiline - which is regarded as the last line of defence against some TB superbugs.
Gary Kantor, senior clinical consultant at Discovery Health, said the global rise of superbugs threatened "a return to the pre-antibiotic era" when surgery was often the only weapon against serious infections. "Unfortunately, very little is being done outside hospitals. Discovery has used its member magazine to highlight the problem and dispense advice with regard to the responsible use of antibiotics, and other consumer forums have done or should do the same."
A group of doctors have launched an advocacy group called TB-Proof, led by Dalene von Delft, a doctor who became infected with multidrug-resistant TB at work.
"I just developed a dry cough," she said. "I wasn't too concerned because I didn't have any other symptoms. Then I went for a screening and I got the fright of my life. I had a huge cavity on one lung that I was completely unaware of."
She said there was a misconception that only people with weak immune systems would fall prey to drug-resistant bacteria.
Briette du Toit, spokeswoman for the Mediclinic hospital group, said the medical fraternity was concerned. "We see more and more patients who are already colonised with multidrug-resistant organisms on admission to hospitals."