The Sunday Mail
Shamiso Yikoniko
THE world is in the midst of an emerging antimicrobial resistance crisis (AMR) which is threatening the effective prevention and treatment of an ever-increasing range of infections caused by bacteria, parasites, viruses and fungi. Epidemic antibiotic resistance has been described in numerous pathogens, in varying contexts and including the global pandemic of drug resistance.
Given their breath of effect and significant impact on morbidity and mortality, multi-drug resistant microbes are considered a substantial threat to world health.
In the meantime, microbes continue to become more resistant, the antibiotic pipeline continues to diminish and the majority of the public remains unaware of this critical situation.
The World Health Organisation (WHO) anticipates that AMR will lead to 10 million deaths each year. WHO adviser, Dr Stanley Midzi, said AMR is a cause for concern.
“It is an increasingly serious threat to global public health that requires action across all Government sectors and society,” he said. “Without effective anti-infective treatment, many standard medical treatments will fail or turn into very high risk procedures.”
WHO defines AMR as a resistance of a micro-organism to an anti-microbial drug that was originally effective for treatment of infections.
“Resistant micro-organisms (including bacteria, fungi, viruses and parasites) are able to withstand attack by anti-microbial drugs such as antibacterial drugs (antibiotics), antifungals, antivirals and anti-malarials, so that treatments become ineffective and infections persist, increasing the risk of spread to others,” added Dr Midzi.
In 2012, WHO reported a gradual increase in resistance to HIV drugs. Since then, further increases in resistance to first-line treatment drugs were reported, which might require more expensive drugs in the near future.
Zimbabwe is not spared on this phenomenon as approximately 15 337 people are on second line anti-retroviral drugs treatment. In 2013, there were about 480 000 new cases of multi-drug resistant tuberculosis (MDR-TB) worldwide with 820 cases recorded in Zimbabwe.
MDR-TB requires treatment courses that are much longer and less effective than those for non-resistant TB. Extensively drug resistant tuberculosis (XDR-TB) has been identified in 100 countries. Although MDR-TB is a growing concern, it is largely under reported, thereby compromising control efforts.
Gonorrhoea may soon become untreatable as treatment failures due to resistance to treatments of last resort (third generation cephalosporins) have been reported from 10 countries.
As if that is not enough, there are high proportions of antibiotic resistance in bacteria that cause common infections (urinary tract infections, pneumonia, bloodstream infections) in all regions of the world.
In parts of the Greater Mekong sub region, resistance to the best available treatment for falciparum malaria has been detected and this could jeopardise important recent gains in control of the disease.
Self-prescribing antibiotics is a big problem.
The most common conditions patients reported self-treating with antibiotics are sore throat, runny nose or cough-conditions that typically would get better without any antibiotic treatment.
Medicines Control Authority of Zimbabwe medicines assessor, Dr Zivanai Makoni urged people to desist from self-prescribing medicines as these are contributing to the AMR threat.
“Self-prescribing medicines come with the risk of taking fake drugs and the public isn’t aware of the dangers,” said Dr Makoni.
A 2014 report on global surveillance of antimicrobial resistance by WHO revealed that antibiotic resistance is no longer a prediction for the future; it is happening right now, across the world, and is putting at risk the ability to treat common infections in the community and hospitals.
Patients with infections caused by drug-resistant bacteria are generally at increased risk of worse clinical outcomes and death, and consume more health care resources than patients infected with the same bacteria that are not resistant.
The evolution of resistant strains is a natural phenomenon that occurs when micro-organisms replicate themselves erroneously or when resistant traits are exchanged between them. The use and misuse of antimicrobial drugs accelerates the emergence of drug resistant strains.
Poor infection control practices, inadequate sanitary conditions and inappropriate food-handling encourage the further spread of antimicrobial resistance. Moreover, about 60 percent of all human disease and 75 percent of all emerging infectious diseases are transferable from animals to humans.
Zimbabwe Association of Church-related Hospitals acting director, Dr Chidzewere Nzou said AMR in food animals is a risk to public health. “More than 200 diseases are spread through food and food borne diseases affect vulnerable people harder than other groups,” said Dr Nzou.
“This comes about when farmers fail to follow the withdrawal periods after treating animals and go on to slaughter them while they still have traces of antibiotics in their body which leads to consumers being exposed to sub lethal doses of antibiotics.
“Farmers also have a tendency of buying antimicrobials (especially penicillin and tetracycline) and treat their animals without consulting a veterinarian, a behaviour which also poses a risk to humans.”
Without urgent, co-ordinated action, the world is heading towards a post antibiotic era, in which common infections and minor injuries, which have been treatable for decades, can once again kill.
When infections become resistant to first line drugs, more expensive therapies must be used. A longer duration of illness and treatment, often in hospitals, increases health care costs as well as economic burden on families and societies.
The achievements of modern medicine are put at risk by antimicrobial resistance. Without effective antimicrobials for prevention and treatment of infections, the success of organ transplantation, cancer chemotherapy and major surgery would be compromised.
Dr Midzi added that individuals can help tackle resistance by hand washing to prevent transmission of bacterial infections and viral infections such as influenza or rotavirus, and using condoms to prevent the transmission of sexually transmitted infections.
Getting vaccinated, keeping vaccinations up to date, using antimicrobial drugs only when they are prescribed by a certified health professional, completing the full treatment course (which in the case of antiviral drugs may require life-long treatment), even if they feel better and never sharing antimicrobial drugs with others or using leftover prescriptions are some of the measures that can be taken.
In September, the United Nations will hold a high-level meeting on antimicrobial resistance at the General Assembly in New York. Global leaders will meet to commit to leading the fight against antimicrobial resistance.
Worldwide antibiotic resistance is not fully mapped, but poorer countries with weak healthcare systems are more affected. The on-going explosion of antibiotic resistant infections continues to plague the global sphere.
