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The Threat To Medical Breakthrough

By Jamila Akweley Okertchiri
Opinion The Threat To Medical Breakthrough
MAY 23, 2015 LISTEN

The discovery of antibiotics in September 1928 by Alexander Fleming transformed medicine in the treatment and prevention of bacterial infections.

Prior to this life saving drug, many people were getting killed by bacterial infections. But together with vaccination, the medical discovery led to the near eradication of diseases such as tuberculosis in the developed world.

Later, other antibiotics were discovered to treat greater number of diseases and indeed it is not necessary to reiterate here how many lives they have saved and how significantly they have contributed to the control of infectious diseases that were the leading causes of human morbidity and mortality for most of human existence.

Despite these great outcomes of the discovery of antibiotics, it is sad to note that the effectiveness and easy access to these antibiotics such as Penicillins, Lipopeptides, Oxazolidinones, Trimetoprim, Streptogramins, Quinolones and Lincosamides have led to their overuse or abuse.

Antibacterial Resistance
This situation, termed antimicrobial resistance, occurs when microorganisms such as bacteria, viruses, fungi and parasites change in ways that render the medications used to cure the infections they cause ineffective.

When the microorganisms become resistant to most antimicrobials, they are often referred to as 'superbugs'.

Antibiotic resistance causes people to fall sick for longer periods and increases the risk of death.

For example, people with Methicillin-Resistant Staphylococcus Aureus (MRSA) are estimated to be 64% more likely to die than people with a non-resistant form of the infection.

Resistance also increases the cost of healthcare with lengthier stays in hospitals and more intensive care.

This is a major concern because a resistant infection may kill, can spread to others, and impose huge costs on individuals and society at large.

This situation is a threat to the medical breakthroughs of the last century, as bacterial treatment could be lost through the spread of antimicrobial resistance.

Antibiotics being sold in open market
Global Threat
The Director of Special Medicines at the WHO office in Ghana, Mrs Edith Andrew-Annan, saidover the past years, the use and misuse of antimicrobials have increased the number and types of resistance organisms.

She said consequently many infectious diseases may one day become uncontrollable, since with the growth of global trade and travel, resistance microorganisms can spread promptly to any part of the world.

The World Health Organisation (WHO) has classified antimicrobial resistance as a “serious threat that is no longer a prediction for the future, but something that is happening right now in every region of the world and has the potential to affect anyone of any age in any country.'

The report—Antimicrobial Resistance: Global Report on Surveillance 2014—showed that antimicrobial resistance has assumed a global dimension and has the potential to affect anyone in any part of the world.

'This is the single greatest challenge in infectious diseases today,' said Dr Keiji Fukuda, WHO's Assistant Director-General for Health Security.

'All types of microbes—including many viruses and parasites—are becoming resistant to medicines. Of particularly urgent concern is the development of bacteria that are progressively less treatable by available antibiotics. This is happening in all parts of the world, so all countries must do their part to tackle this global threat,' he added.

Ghana's Situation
There are a lot of reasons for Ghana to be concerned with this global blight as the country suffered a scare of this phenomenon in early 2012.

It would be recalled that the Korle Bu Teaching Hospital (KBTH) had to close down its children's emergency ward due to the outbreak of a bacterial infection known as Methicillin-Resistant Staphylococcus Aureus (MRSA).

The hospital officials had to take extra measures to ensure the bacterial infection did not spread beyond the Children's Department as they contained it.

Also, a study by a group of university professors to identify the agents of bacterial infection in Ghana, determine their antibiogram and the possibility of setting up a surveillance programme showed that a wide range of bacterial isolates were identified in both teaching and regional hospitals.

The prevalence of drug resistance among the bacteria was high.

Four antimicrobial agents had very high prevalence of resistance, namely tetracycline (82%), ampicillin (76%), chloramphenicol (75%), and cotrimoxazole (73%); and for these drugs, the prevalence of resistance was higher in the regional than in the teaching hospitals.

In addition, these are drugs that have been reported as having high percentage resistance for a number of microorganisms for several years.

The rate of resistance has been rising over the years, not only for clinical isolates but also for the normal intestinal flora of the healthy population.

Prof Mercy J. Newman, a lecturer at the Department of Microbiology at the University of Ghana (UG), said the country faces a threat as most antibiotics were not effective because bacteria-causing diseases had developed some resistance to them.

'Therefore, the more you use antibiotics, the more you select for the resistance strain. So if the bacteria number a million and all of a sudden you are using antibiotics, one or two of these bacteria will become resistant and as such start multiplying very fast and before you know it, the resistant one has taken over or the antibiotic will kill the sensitive ones and the resistant ones will continue to grow,' she said.

Challenges
Global organisations, led by WHO, have over the past few years worked to raise awareness of the problem and find workable solutions to it.

However, certain challenges still persist, which may delay the progress being made towards fighting the growing trend.

A survey conducted by WHO to find out steps taken by countries to preserve antimicrobial drugs like antibiotics indicates that systems needed to combat antibiotic resistance are lacking in majority of the countries surveyed.

'While there is a lot to be encouraged by, more work needs to be done to combat one of the most serious global threats of our time,' DrFukuda said.

Issued a year after WHO's first report on the extent of antimicrobial resistance globally, which warned of a 'post-antibiotic era', this survey—which was completed by 133 countries in 2013 and 2014—is the first to capture governments' own assessments of their response to resistance to antimicrobial medicines used to treat conditions such as bloodstream infections, pneumonia, tuberculosis (TB), malaria and HIV.

It summarises current practices and structures aimed at addressing the issue, and shows there are significant areas for improvement.

Few countries—34 out of 133 participating countries—in the survey have a comprehensive national plan to fight resistance to antibiotics and other antimicrobial medicines.

According to the report, monitoring is key in controlling antibiotic resistance. However, it observes that this (monitoring) is infrequent, adding that in many countries poor laboratory capacity, infrastructure and data management are preventing effective surveillance which could reveal patterns of resistance and identify trends and outbreaks.

It also notes that the sale of antibiotics and other antimicrobial medicines without prescription remains widespread, with many countries lacking standard treatment guidelines; thus, increasing the potential for the abuse of antimicrobial medicines by the public and medical professionals.

Another key finding is the low public awareness of the issue in the region, with many people still believing that antibiotics are effective against viral infections.

Furthermore, the lack of programmes to prevent and control hospital-acquired infections remains a major problem.

'Scientists, medical practitioners and other authorities, including WHO, have been sounding the warning of the potentially catastrophic impact of ignoring antibiotic resistance,' Dr Fukuda said.

Solutions
The report reveals that key tools to tackle antibiotic resistance such as basic systems to track and monitor the problem show gaps or do not exist in many countries.

While some countries have taken important steps in addressing the problem, every country and individual needs to do more.

Other important actions include preventing infections through better hygiene, access to clean water, infection control in healthcare facilities and vaccination to reduce the need for antibiotics.

WHO is also drawing attention to the need to develop new diagnostics, antibiotics and other tools to allow healthcare professionals to stay ahead of emerging resistance.

This will involve the development of tools and standards and improved collaboration around the world to track drug resistance, measure its health and economic impacts and design targeted solutions.

People can help tackle resistance by using antibiotics only when prescribed by a doctor, completing the full prescription even if they feel better, never sharing antibiotics with others or using leftover prescriptions.

Health workers and pharmacists can help tackle resistance by enhancing infection prevention and control, only prescribing and dispensing antibiotics when they are truly needed, and prescribing and dispensing the right antibiotic(s) to treat illness(es).

Policymakers can help tackle resistance by strengthening resistance tracking and laboratory capacity, regulating and promoting appropriate use of medicines, fostering innovation and research, developing new tools, and promoting cooperation and information sharing among all stakeholders.

By Jamila Akweley Okertchiri

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