Multi-pronged approach in fighting AMR

Dr Dena van den Bergh, director: quality leadership at Netcare, says the increasing incidence of antibiotic resistant organisms has highlighted the importance of correct antibiotic prescribing, including “bug-drug matching”, use of narrower spectrum antibiotics, appropriate duration of the course of treatment and correct dosage.

“At the same time, patients also contribute to antibiotic resistance when they pressure their doctors to prescribe antibiotics to treat non-bacterial infections, and by not taking the antibiotics as prescribed.”

Antibiotics are used to treat bacterial infections such as pneumonia, ear infections, strep throat, tuberculosis (TB) and urinary tract infections. Antibiotics are not effective against viruses, such as the common cold or influenza.

What is antibiotic resistance?

Bacteria are constantly evolving, producing different “strains” which have slight differences in their genetic make up. Just as humans can build up resistance to certain types of illness, the evolution of bacteria strains enables them to develop resistance to the antibiotics we rely on to treat bacterial infections.

This means that the antibiotic loses its ability to effectively control or kill bacterial growth, and the bacteria are increasingly able to withstand or resist the curative effect of antibiotic drugs and continue to multiply. In other words, the antibiotic was once able to kill off the bacteria and treat the infection but, due to development of resistance, that antibiotic has now become ineffective in treating the infection.

Why is there global concern with regard to antibiotic resistance?

Antibiotic resistance is now a global problem, as it has risen to dangerously high levels in many parts of the world. Common infectious illnesses such as pneumonia, tuberculosis and gonorrhoea are becoming more difficult to treat because the antibiotics used to treat them are becoming less effective.

Without antibiotics that work, essential medical procedures like hip operations, caesarean sections, organ transplants and treatments such as chemotherapy would be much more risky.

If we do not take urgent action we will soon head for a post-antibiotic era, in which common infections and minor injuries will once again cause death and disability. This would also lead to higher medical costs and prolonged hospital stays. Already, in the European Union alone, it is estimated that drug-resistant bacteria cause 25,000 deaths and cost more than US$1,5bn each year in healthcare expenses and productivity losses.

What are multi-drug resistant germs?

Multi-drug resistant (MDR) bacteria are germs that have developed resistance to at least three different antibiotics. These are particularly dangerous to patients who have other underlying health problems or injuries, or are undergoing surgery, for example.

Internationally and in South Africa, we urgently need to change our patterns of antibiotic prescription and usage. Without such behavioural change, antibiotic resistance will remain a major threat even if new medicines are developed.

How is the World Health Organisation (WHO) responding to this threat?

The WHO has flagged antibiotic resistance as a high priority issue, endorsing a global action plan on antibiotic resistance at the World Health Assembly in May 2015. The global action plan aims to ensure the prevention and treatment of infectious diseases with safe and effective medicines continues.

The global action plan has five strategic objectives:

• To improve awareness and understanding of antimicrobial resistance

• To strengthen surveillance and research

• To reduce the incidence of infection

• To optimise the use of antimicrobial medicines

• To ensure sustainable investment in countering antimicrobial resistance

During the first annual World Antibiotic Awareness Week in November 2015, the WHO launched and led a global campaign with the theme: Antibiotics: Handle with care. The organisation is supporting member states to develop their own national action plans to address antimicrobial resistance, aligned with the objectives of the global plan.

In terms of the initiative, interventions should be made at four levels: the general public, healthcare workers including pharmacists, policymakers and the agricultural sector.