Antimicrobial resistance: An emerging human health related global issue!

“Giving antibiotics to your patient is like giving them water from a well with a limited supply. You better make sure they need it because there are thousands/millions lined up behind them with the same symptoms.” -Nicholas Torney

Antimicrobials are the drugs used to treat infections in humans and animals. These include antibiotics, antivirals, and antifungal medicines. Antimicrobial resistance (AMR) means that the bacteria, viruses, and fungi transform over time through genetic mutations, and threaten our ability to treat common infections. The antimicrobial medicines become futile, and disease becomes resistant to treatment. At times, it becomes challenging to treat the diseases caused by the microbes and increases the disease-related morbidity and mortality.

With the easy availability and frequent use of antibiotics, multidrug resistance against the “superbugs” has emerged as a global problem. As an estimate, even in the developed nations for example in the United States, at least 2.8 million people get an antibiotic-resistant infection, and more than 35,000 people die every year. To combat this trend, antibiotic stewardship program is getting implemented worldwide to draw attention to the rising incidents in mortality and morbidity associated with inappropriate use of antibiotics. The main factors underlying AMR include the frequent and wrong usage of antibiotics; scarce access to clean water, sanitation and hygiene (WASH) for both humans and animals; lack of standardized and affordable medicines, vaccines and diagnostics; lack of mindfulness and knowledge; and lack of execution of antimicrobial stewardship.

Antimicrobial stewardship is a team game with the patient at the center; it is our teamwork that makes the dream work.” 

The inadvertent use of antibiotics for common bacterial infections, including the common cold, sore throat, pneumonia, urinary tract infections, sepsis, as well as gut infections have led to drug-resistant, signifying that we are running out of effective antibiotics. The antibiotic resistance has resulted in prolonged hospital stay of the patient, more expensive and intensive care, and more economic burden on the caretakers. We need new drugs with better potency for community-acquired common infections. If the quack practice of frequent antibiotics usage and self-medication is not changed, the new antibiotics will suffer the same fate as the current ones and become ineffective. This use of antibiotics needs a balanced approach.

 “Do not be the first to use an antibiotic, because you risk toxicity. Do not be the last to use an antibiotic, because you risk efficacy.” 

World Health Organization (WHO) survey has revealed that there are many countries throughout the world where the treatment is now ineffective in the majority of the patients. The two most frequently encountered community and hospital-acquired superbugs leading to bloodstream infections are methicillin-resistant Staphylococcus aureus (MRSA) and E. coli resistant to third-generation cephalosporin like Ceftriaxone. A famous saying is: “Fever is not a sign of ceftriaxone deficiency.”

In the developing countries including Pakistan where Tuberculosis (TB) is endemic. Multi-drug resistant strains, resistant to the two most powerful anti-TB drugs, (MDR-TB) are threatening its pandemic spread. In 2018, WHO estimated that there were about half a million new cases globally who had MDR-TB. MDR-TB requires extended treatment course, far more expensive than those for non-resistant TB. According to an estimate, less than 60% of those treated for MDR-TB get treated successfully. Similarly, resistance is encountered in malaria and endemic diarrheal disease-causing parasites.

AMR is a multifaceted dispute that requires an integrated multispectral approach. The solution is the implementation of strategy planners, guidelines, regulation and research to accomplish better public health outcomes. The government needs more investment of funds for the health sector to accelerate research on the development of new antibiotics and antibiotic alternatives, vaccines, and diagnostic tools. The top of all we need education and provision of clean drinking water and self-hygiene practice for a common man. The overuse of self-medication and quackery practice should be prohibited through the implementation of strict legislations by the medical association.

“Antibiotics kill bacteria, not your anxiety. Stop the ‘just-in-case’ indications.”

World Antibiotic Awareness Week is one of the steps aiming to raise awareness of antimicrobial resistance worldwide and encourage best practices among the general public, health workers and policymakers to hasten the spread of drug-resistant infections. The medical practitioners need to balance the risk versus benefit ratio stressing on drug interactions, cost, and antibiotic resistance. It’s a common observation that many patients expect to get an antibiotic when they visit a physician for an issue they perceive as bacterial. An informative discussion with the patient is necessary to modify the overprescribing approach. They need education on the viral aetiology of different infectious disease syndromes in which antibiotics are needless. The medical specialist should adopt a comprehensive approach to promoting the optimal use of antibiotic agents, including their choice, dosing, route, and duration of administration.

“To learn how to use antibiotics, one must first learn how not to use antibiotics.”

Without an effective strategy to prevent and manage drug-resistance, and easy availability of quality-assured antimicrobials, the disease-related morbidity and mortality will escalate. The danger of acquiring multi-resistant infections during the surgical procedures, cancer chemotherapy, and organ transplantation, will render them more perilous. The implementation of stewardship programs leads to health and economic benefits. Economic outcomes do not only refer to the antimicrobial expenditures but also include the length of stay, diagnostics and infectious disease specialists. More significant results can be achieved with improved clinical outcomes due to short hospital stays, conserving the intensive medical resources, and reduction in complications related to antibiotic use.

The article has been co-authored by Dr. Maimoona Siddique and Dr. Aitzaz  Bin Sultan Rai.

Disclaimer: The views expressed in the article are the author’s own and do not necessarily reflect Dunya News’ editorial stance.

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