Antimicrobial resistance a great challenge to global public health

By Lilian Bulage

Antimicrobial resistance is one of the greatest challenges to global public health and is on the increase.

According to the World Health Organization (WHO), 2014, over the past 30 years, no major new types of antibiotics have been developed; yet, high levels of resistance on commonly available and used antibiotics have been reported in all regions of the world.

This state, therefore, may lead to a situation whereby common infections and injuries can once again kill. Antimicrobial resistance is a situation whereby a microorganism/germ no longer responds to a drug that they were originally effective to in the treatment of infections caused by it.

Resistant microorganisms can spread rapidly across countries, regions and the world, facilitated by global trade, travel and tourism. Poor infection control in any setting can also greatly increase the spread of drug-resistant infections, especially during outbreaks of disease and conflict situations.

Lack of comprehensive data on the prevalence of antimicrobial resistance and its impact on health outcomes, the associated economic costs is a major barrier in recognition of the antimicrobial resistance as a public health problem in resource limited settings such as Africa.

The available data shows that the African region shares an increasing trend of drug resistance with the rest of the globe. Significant resistance has been reported for diseases such as cholera, dysentery, typhoid, meningitis, gonorrhea, TB, malaria and HIV/AIDS (WHO, 2013).

For the case of tuberculosis as an example of antimicrobial resistance; Mycobacterium tuberculosis, the organism which causes TB, has become resistant to the cheaply available first line drugs leading to another complicated form called Multidrug Resistant (MDR) TB. Worldwide, in the year 2013, there were 136 000 MDR-TB cases detected and only 97 000 cases were started on treatment (WHO, 2014).

There are limited chances of cure when a patient is infected with this form of TB. Only 50% of the patients who access treatment cure. The second line TB drugs used for treatment of MDR TB are very expensive, about 200 times compared to the sensitive TB. The drugs have to be taken for about 18-24 months and are associated with serious side effects (WHO, American lung association, 2013).

A study on antibiotic resistant infections (ARIs) in hospitals conducted in the USA showed that the death rate for patients with ARIs was two times higher than the death rate for patients without ARIs. Patients infected with antimicrobial-resistant organisms were more likely to have had longer hospital stays and required more complicated treatment (National Institute of Allergy and Infectious Diseases).

Drug resistant infections are associated with high costs and strain the economy. According to the Centers for Disease Control and Prevention , 2011, “antibiotic resistance in the United States costs an estimated $20 billion a year in excess health care costs, $35 billion in other societal costs and more than 8 million additional days that people spend in the hospital”.

Use of complicated medications, long treatment durations, highly trained specialized human resource, sophisticated equipment and infrastructures are required which is very costly.

Although antimicrobial resistance is a natural phenomenon, it’s increase is being propagated by a number of factors such as misuse of antimicrobial medicines, inadequate or inexistent programmes for infection prevention and control, poor-quality medicines, weak laboratory capacity, inadequate surveillance and insufficient regulation of the use of antimicrobial medicines in the health care systems (WHO, 2015)

Most often antibiotics are prescribed for no useful purpose in resource limited settings. The wide availability of medicines for direct sale to patients by drug shops, drug hawkers and pharmacies remains a problem in Uganda and Africa at large.

Systems for monitoring use of antimicrobial medicines are either weak or lacking in most of the African countries; thus making it difficult to track prescribing patterns and over the counter sales. Counterfeit medicines have been reported to be a problem in many regions of Africa (WHO, 2015). The situation stems from weak regulatory systems and inability to enforce laws by different authorities (WHO, 2015)

National surveillance mechanisms and the necessary laboratory capacity are very essential to detect, analyze and track resistant microorganisms and prompt reporting to the relevant authorities. Surveillance can reveal the presence of patterns of resistant microorganisms and identify trends and outbreaks.

However, public health laboratories in the African region are struggling with limited resources, inadequate staffing, equipment and supplies (WHO, 2010)

As an individual, you need only to use antibiotics/medicines when prescribed by a health professional, complete the full dose even when you’re feeling well, never share medication with others and do not use leftover prescriptions.

The writer is MaKSPH-CDC-MoH, Public Health Fellowship Programme-Field Epidemiology Track Fellow