Thursday, February 16, 2017

Antibiotic resistance is the next global epidemic

Professor Zulfiqarali Premji

Professor Zulfiqarali Premji 

Recently in The Citizen an article was published entitled; Powercef: Medicine widely used and ‘abused’ in TZ. The scientific name of Powercef is Ceftriaxone. This prompted me to write this article and put the issue of antibiotic resistance in perceptive by an infection diseases expert from a developing country like Tanzania. Rapidly emerging resistant bacteria threaten the extraordinary health benefits that have been achieved with antibiotics.

This crisis is global, reflecting the worldwide overuse of these drugs and the lack of development of new antibiotic agents by pharmaceutical companies to address the challenge. Antibiotic-resistant infections place a substantial health and economic burden on the global health care system thus coordinated efforts to implement new policies, renew research efforts, and pursue steps to manage the crisis are greatly needed.

New resistance mechanisms are emerging and spreading globally, threatening our ability to treat common infectious diseases, resulting in prolonged illness, disability, and death. Without effective antibiotics for prevention and treatment of infections, medical procedures such as organ transplantation, cancer chemotherapy, diabetes management and major surgery (for example, caesarean sections or hip replacements) become very high risk. Antibiotic resistance increases the cost of health care with lengthier stays in hospitals and more intensive care required. Antibiotic resistance is putting the gains of the Millennium Development Goals at risk and endangers achievement of the Sustainable Development Goals.


What is Antibiotic resistance?

Antibiotic resistance occurs when an antibiotic has lost its ability to effectively control or kill bacterial growth; in other words, the bacteria are “resistant” and continue to multiply in the presence of adequate levels of an antibiotic.


Why do bacteria become resistant to antibiotics?

Antimicrobial resistance occurs naturally over time, usually through genetic changes. However, the misuse and overuse of antimicrobials is accelerating this process. In many places, antibiotics are overused and misused in people and animals, and often given without professional oversight. Examples of misuse include when people take them with viral infections like colds and flu, and when they are given as growth promoters in animals and fish. Antimicrobial resistant-microbes are found in people, animals, food, and the environment (in water, soil and air). They can spread between people and animals, and from person to person. Poor infection control, inadequate sanitary conditions and inappropriate food handling encourage the spread of antimicrobial resistance.

The global action plan sets out five strategic objectives to address this global issue:

1. To improve awareness and understanding of antimicrobial resistance;

2. To strengthen knowledge through surveillance and research;

3. To reduce the incidence of infection;

4. To optimise the use of antimicrobial agents; and

5. Develop the economic case for sustainable investment that takes account of the needs of all countries, and increase investment in new medicines, diagnostic tools, vaccines and other interventions.

In a developing country like Tanzania and most other countries in sub-Saharan Africa where burden of illness is huge, the cost of health care provision is increasing and to implement the above strategies is next to impossible. Laboratories services are not widely available hence microbial diagnosis is minimum and empirical treatment with antibiotics is widely practiced. In this scenario it is difficult to optimise the use of antibiotics and the latest antibiotics are available as over the counter drugs (without prescription). This is an honest view and a reality, sub-Saharan Africa and perhaps other developing countries in the world will not be able to address this issue.

However there is something more to antibiotic resistance. In the developed world the above outlined five strategies are being stringently followed. For example in USA can you buy antibiotics without a prescription-the answer is definitely NO. They have a good surveillance and infection control system especially hospital related infections and awareness about this is high. If they are doing all this then WHY ARE THEY REGISTERING CASES OF ANTIBIOTIC RESISTANCE? This is a valid question and perhaps the major cause of antibiotic resistance is not captured by these five strategies. The major cause is extensive agricultural use

In the developed world, antibiotics are widely used as growth supplements in livestock. An estimated 80 per cent of antibiotics sold in the U.S. are used in animals, primarily to promote growth and to prevent infection. Treating livestock with antimicrobials is said to improve the overall health of the animals, producing larger yields and a higher-quality product. So its all about profits from the livestock industry and is primarily driven by human greed for more wealth.