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Combating the Global Threat to Public Health

Mar 30 2017 - As can be seen by global reports, in the vast majority of cases where antimicrobials are used, the microorganisms have found a way to evade or resist the antimicrobial agent. Resistance occurs wherever antimicrobials are used — in the community, on the farm, and in healthcare. Antibiotic resistance is a public health problem of increasing magnitude, and finding effective solutions to address this problem is critical.

Infections with resistant bacteria were first reported over 67 years ago. Antimicrobial is a general term for the drugs, chemicals, or other substances that either kill or slow the growth of microbes. Among the antimicrobial agents in use today there are antibiotic drugs (which kill bacteria), antiviral agents (which kill viruses), antifungal agents (which kill fungi), and antiparisitic drugs (which kill parasites). An antibiotic is a type of antimicrobial agent made from a mold or a bacterium that kills, or slows the growth of other microbes, specifically bacteria.

Early on the problem was often overlooked, because if one antibiotic did not treat the infection, another was usually available. Since then, infections with resistant bacteria have become more common in healthcare and community settings, and many bacteria have become resistant to more than one type or class of antibiotics. Consequently, doctors and nurses today are faced with treating infections where antibiotic options are very limited, and in some cases, where no effective antibiotics exist.

The use of antibiotics at any time in any setting puts biological pressure on bacteria that promote the development of resistance. When antibiotics are needed to prevent or treat disease, they should always be used. But research has shown that as much as 50 percent of the time, antibiotics are prescribed when they are not needed or are misused (for example, a patient is given the wrong dose). This inappropriate use of antibiotics unnecessarily promotes antibiotic resistance.

A reason why the use of antibiotic is so high is poor understanding and awareness of the differences between bacteria, viruses and other pathogens, and of the proper use and value of antibiotics. Especially in Bangladesh, antibiotics are very often unnecessarily prescribed. Too many antibiotics are prescribed for viral infections such as colds, flu and diarrhea. Unfortunately, public misconceptions regarding the effectiveness of antibiotics are often perpetuated by print and electronic media, where, until recently, antibiotics would be indiscriminately recommended.

Through the use of generic terms such as ‘germs’ and ‘bugs’, in a recent report the World Health Organisation (WHO) focused on determining the rate of antibiotic resistance to seven bacteria responsible for many common infections, including pneumonia, diarrhea, urinary tract infections, gonorrhea and sepsis. Their findings were worrying. The report revealed that resistance to common bacteria has reached “alarming” levels in many parts of the world, with some regions already out of treatment options for common infections. In fact, it has been found that resistance to carbapenem antibiotics used to tackle Klebsiella pneumoniae – the bacteria responsible for hospital-acquired infections such as pneumonia and infections in newborns – has spread to all parts of the globe.

Antibiotic resistance occurs as part of a natural process in which bacteria evolve; this process can be slowed but not completely stopped. Therefore, new antibiotics will always be needed to keep up with resistant bacteria, as will new tests to track the development of resistance. But developing new antibiotics alone will not be enough to tackle resistance to these drugs. There needs to be a drastic change in the way antibiotics are prescribed by doctors and used by patients, since this has been a key contributor to resistance. WHO recommends that patients only use antibiotics when they are prescribed the drugs by a doctor. Furthermore, patients should take the full prescription, even if they are feeling stronger, and they should never share antibiotics with others or use leftover antibiotics. When it comes to healthcare workers, WHO states they should only prescribe antibiotics when patients truly need them, and should ensure that they are prescribing the correct antibiotic to treat the illness. One way of tackling antibiotic resistance is to prevent infection, thereby reducing the amount of antibiotics that have to be used. How do we prevent infections, you ask? There are a number of ways: immunisation, infection prevention actions in healthcare settings, safe food preparation and handling and general hand washing. Also, basic research on antimicrobial resistance on a national level is a must.

With the growing development of antibiotic resistance, it is imperative that we no longer take the availability of effective antibiotics for granted. As a nation, we must respond to this growing problem, and our response needs to be multifaceted, addressing all disciplines.

The writer is a medical practitioner.

This story was originally published by The Daily Star, Bangladesh