Resistance to drugs one of the globe’s biggest challenge

By Dr. Denis K. Byarugaba

TODAY April 7 is the World Health Day with a theme “Antimicrobial resistance; No action today, no cure tomorrow”. Antimicrobial resistance is one of the biggest challenges facing global public health at the moment and threatening to take back public health efforts decades back.

There is no doubt that antimicrobial drugs have saved many lives and eased the suffering of many millions. Antimicrobial agents combined with improvement in sanitation, housing and nutrition and the advent of widespread immunisation programmes, have led to a dramatic drop in deaths from diseases that were previously widespread, untreatable and frequently fatal.

However, there is an increasing decline in effectiveness of existing antimicrobial agents and thus infections have become more difficult, expensive to treat and epidemics harder to control. This has contributed to high morbidity and mortality of previously treatable infectious diseases such as tuberculosis, malaria, acute respiratory diseases and diarrhoea. In developing countries in particular, the situation remains worse than that of previous generations of the industrialised nations.

Preventable infectious diseases are still present, threatening life and people’s livelihood, causing death and suffering of the underprivileged population due to poverty, hunger and inadequate access to health care.

The emergence of multi-drug-resistant organisms that cause tuberculosis, acute respiratory infections and diarrhoea, often referred to as diseases of poverty, has had its greatest toll in developing countries. The epidemic of HIV/AIDS, with over 30 million cases in developing countries, has greatly enlarged the population of patients who are resistant to drugs. Such patients are frequently challenged by infectious agents and thus require frequent use drugs.

The disease has left these patients at great risk of numerous infections and even greater risks of acquiring highly resistant organisms during long periods of hospitalisation.

The emergence of antimicrobial resistance is a complex problem driven by numerous interconnected factors, many of which are linked to the use of antimicrobial agents. The increased use of antimicrobial agents has increased selective pressure on organisms, and as the opportunity for organisms to be exposed to the agents is extended, so is their opportunity to acquire ways of resistance. It is now accepted that antimicrobial use is the single most important factor responsible for increased antimicrobial resistance.

Antimicrobial use is influenced by the interplay of knowledge, expectations, and interactions of prescribers and users, economic incentives, characteristics of the health care systems, the regulatory environment as well as the bigger framework of the countries resources and governance.

Extreme poverty in most developing countries translates into misuse of the antimicrobial agents. This is further complicated by unending conflicts and civil wars that are related to resource sharing. The little available resources often have to be priotised and channelled towards other sectors. The spread of micro-organisms resistant or not, does not respect international borders despite stringent restrictions by certain countries thus calling for global solutions.

The prudent use of the antimicrobial agents will play a very big role in the overall control of antimicrobial resistance. The improvement of antimicrobial use in order to contain antimicrobial resistance is very crucial.

Several recommendations have been made and these revolve around a combination of educational measures, regulatory and managerial issues.

Educational measures, sensitisation and training interventions are very important especially for developing countries as most stakeholders do no appreciate antimicrobial resistance as a problem or as a potential problem in future.

With proper sensitisation of all stakeholders, handling drug resistance will be much easier as proper policies will be formulated, services delivered professionally and the users use the drugs properly.

It is not simple because some of the factors causing drug resistance are complicated and not easy to overcome. Aspects like poverty and lack of resources to provide proper services or even do the sensitisation itself are not easy to deal with.

A greater interaction between informed policy makers, service providers and users on antimicrobial drug use and their dangers and planning together to identify possible solutions will go a long way in improving antimicrobial use. This partnership is also essential in influencing policies such as incorporation of proper antimicrobial use in education systems.

Friendly policies that address the realities at different times and thorough situational analysis of issues are a step in the right direction.

The bodies that licence the service providers (health, biomedical, veterinary and allied health sciences) to practice are best placed to regulate the professional conduct. These bodies can play a more active role in policing and apprehending their professional members. For sustainability, these interventions would have to be integrated in the already running programmes such as primary health care. However, a lot of lobbying and advocacy is needed to influence the policies that are generated from time to time. The public is urged to be conscious of the problem of drug resistance and take care on how they use drugs.


Writer is a senior lecturer at Makerere University and President of the Alliance for Prudent use of antibiotics — Uganda Chapter