Pranav Johri, 41 from New Delhi was diagnosed as being Antibiotic resistant when multiple courses of antibiotics did not help treat Chronic Bacterial Prostatitis, a common enough condition. He shares how he dealt with and why he campaigns for AMR awareness.
What were the early symptoms?What made you go to a doctor? What were you prescribed antibiotics for?
In May 2016, I noticed symptoms of a pulling pain in the groin, sensitivity to cold, and daily low-grade fever. I went to a urologist when I realized these symptoms continued to persist without getting any better as weeks passed. The doctor diagnosed my condition to be Chronic Bacterial Prostatitis – an inflammation of the prostate gland caused by a bacterial infection, I was prescribed antibiotics for treating it, which is a standard treatment protocol for this condition.
Were any tests done? How did the diagnosis come about?
I was diagnosed based on my symptoms. No tests were conducted before a diagnosis was made by the doctor, or before antibiotics were prescribed.
What was your reaction to the diagnosis? How and when did you break it to your family?
The impression I got from my initial visit to the doctor was that Chronic Bacterial Prostatitis is a very common diagnosis and would not be difficult to treat. Therefore, my initial reaction mirrored this, and I started the regimen of antibiotics expecting to be cured soon. My family was aware of my symptoms, diagnosis, and treatment from the beginning.
What happened next?
I was initially given a single oral dose of Azithromycin, along with a 10-day course of oral Doxycycline. After the end of these courses, I felt no relief from my symptoms, so the doctor prescribed a 4-week course of oral Ofloxacin.
Despite such a long course of a strong antibiotic, my symptoms were only getting worse over time. Along with my initial symptoms, I would now get chills and shivers and had to wear sweaters all day long in the middle of a hot and humid summer. I also developed pelvic pains and debilitating lower back pains.
When I raised this with the urologist, he was unable to explain my worsening condition and prescribed 3 more weeks of Ofloxacin. At this time, I decided to consult with a different doctor – a senior urologist at a leading hospital in Delhi. He conducted a physical exam and confirmed that I had prostatitis, and ordered a urine culture. This was the first time I was asked to get a culture test done. Though the test result was sterile, the doctor suspected a bacterial infection due to the persistent low-grade fever, and started me on a “heavy artillery” course of oral Ciprofloxacin combined with intravenous Amikacin for 10 days. Unfortunately, the treatment did not cure me at all, and in addition to the symptoms of prostatitis itself, I was left with distressing side-effects from the heavy antibiotics I had been given. By this point, my pains and weakness did not allow me to work anymore, or even sit up for more than an hour at a stretch.
The senior urologist was surprised that the combination treatment did not work. He informed me that since antibiotics were not working, I was likely suffering from an infection that was antibiotic resistant. He advised me to approach my condition from the perspective of symptom management for the rest of my life, and suggested that I should “move on from thinking of the problem as one that would be completely resolved”. This is when I knew I had to look for alternatives.
My search led me to find phage therapy, a century-old treatment for bacterial infections, which pre-dated antibiotics. I read research papers about it on medical and scientific journals and research platforms. It was not available in most countries of the world. One exception was Georgia, which also has the world’s oldest and most advanced phage research institute. After understanding the science of the treatment and gaining an understanding of how it might apply to my condition, I decided to take a leap of faith and travelled to Georgia for my treatment. After three treatment courses with phage therapy, my infection had been successfully treated, and my symptoms had completely abated.
Editor’s Note: Phage therapy is an experimental treatment and not approved by regulators around the world. Various trials are underway. Read reference below for more information
What were you going through when the treatment was not working? Tell about how anxiety set in? What were the triggers and signs?
Despite taking every course of antibiotics that I was prescribed, when my condition only got worse instead of getting better, I was confused about why antibiotics were not working, frustrated at the medical system that was unable to resolve a simple bacterial infection, and was faced with increasing stress and anxiety about my fast-deteriorating health.
How did cope with your anxiety? What worked and what did not?
It was difficult to cope with the anxiety and stress of suffering from an antibiotic resistant infection, and not being able to find any reasonable answers for my condition from the medical system. Some of the specialists that I consulted at this time blamed me for taking on stress and thus making my condition worse, displaying a lack of empathy for a patient suffering from a multidrug resistant infection that they were unable to successfully deal with. These kinds of experiences made me realize that I had to find my own answers.
How did you manage your job during this period? Did you tell the workplace?
I am the fourth-generation entrepreneur of my family’s publishing company. My work was entirely in my hands, and when I realized I am unable to cope with anything more than subsistence level of work, I delegated certain responsibilities to trusted members of our organization, so that work could carry on even in my absence.
Did you have any past history of antibiotic resistance or recurrent and unresolving infections?
I had a recurring upper respiratory tract infection for 5 months prior to contracting Chronic Bacterial Prostatitis. That may or may not have contributed towards developing my prostatitis condition.
What changes have you made to your lifestyles because of this experience?
Left to antibiotics, I may not be alive today. I believe I found a treatment which has given me a new lease of life. The biggest lifestyle change for me has been the awareness and scientific approach with which I approach matters of health for myself and my family.
How did your wife mentally/emotionally cope with it all?
My wife was my rock. She was unwavering in her support of my condition, and the fact that I wanted to try a treatment that was not known in India at that time, nor well understood around the world. Even at times when I would be most angry and dejected at the state of my health, she gave me her calm when I didn’t have any of my own.
Did you see a counselor at any point for support?
No
What were some of the challenges you faced that you have not talked about?
Getting doctors to believe that I was actually physically suffering, and not just “thinking up the problem” was the biggest challenge I faced. Secondly, no doctor in India did comprehensive testing to diagnose the bacterial pathogens or their sensitivities to the antibiotics that they were giving me. I learned of the extent and prevalence of antibiotic resistant infections only when I started looking into alternatives for treating bacterial infections when antibiotics fail.
Why do you think awareness about antibiotic resistance is required?
Awareness of antibiotic resistance is needed amongst doctors as well as the general public so that people realize the major health and financial pitfalls that come with the misuse of antibiotics. Antibiotic resistance is a glaring reality of today. If resistant drugs are taken, they will only harm the patient’s body, not the pathogenic bacteria. Moreover, antibiotics are often unable to treat chronic or recurrent infections due to the presence of bacterial biofilms. Repeated usage of antibiotics over a long term also leads to side effects which can be debilitating or even irreversible in some cases.
This is with the support from Superheroes Against Superbugs, an initiative to raise awareness of AMR in India
Reference:
1. https://www.frontiersin.org/articles/10.3389/fmicb.2023.1250848/full
2. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(05)6675…
