According to WHO http://www.who.int/mediacentre/factsheets/fs194/en/, Antimicrobial resistance (AMR) is resistance of a microorganism to an antimicrobial drug that was originally effective for treatment of infections caused by it. Resistant microorganisms (including bacteria, fungi, viruses and parasites) are able to withstand attack by antimicrobial drugs, such as antibacterial drugs (e.g., antibiotics), antifungals, antivirals, and antimalarials, so that standard treatments become ineffective and infections persist, increasing the risk of spread to others. The evolution of resistant strains is a natural phenomenon that occurs when microorganisms 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 AMR.
According to a recent report by WHO http://www.who.int/drugresistance/en/ , “Antimicrobial resistance (AMR) threatens the effective prevention and treatment of an ever-increasing range of infections caused by bacteria, parasites, viruses and fungi. A post-antibiotic era – in which common infections and minor injuries can kill – far from being an apocalyptic fantasy, is instead a very real possibility for the 21st Century”. It further states that “Antimicrobial resistance (AMR) is an increasingly serious threat to global public health. AMR develops when a microorganism (bacteria, fungus, virus or parasite) no longer responds to a drug to which it was originally sensitive. This means that standard treatments no longer work; infections are harder or impossible to control; the risk of the spread of infection to others is increased; illness and hospital stays are prolonged, with added economic and social costs; and the risk of death is greater—in some cases, twice that of patients who have infections caused by non-resistant bacteria. The problem is so serious that it threatens the achievements of modern medicine. A post-antibiotic era—in which common infections and minor injuries can kill—is a very real possibility for the 21st century”
The report highlights that very high rates of resistance have been observed in bacteria that cause common health-care associated and community-acquired infections (e.g. urinary tract infection and pneumonia) in all WHO regions; and there are significant gaps in surveillance, and a lack of standards for methodology, data sharing and coordination. What this means is that AMR is occurring globally (it is where you are!) and without a coordinated global response! The report points out the common community conditions faced by AMR including Urinary tract infections, blood stream infections, Pneumonia, Wound infections, meningitis, otitis, Foodborne diarrhoea, Diarrhoea (“bacillary dysenteria”), Gonorrhoea, influenza. AMR is also being experienced in the three leading killer diseases (at least in Africa) – Malaria, TB, and HIV/AIDS.
It is therefore good that the WHO is finally recognizing this as a challenge and moving to coordinate a global AMR surveillance response. However, as community based practitioners and consumers of health care, the recognition of AMR may not come as news. We have been paying the price for some time now. For example the cost of managing pneumonia often goes up 10 times whenever, patients fail to respond to a course of oral first line antibiotics that costs about 4USD on the Uganda market. This is because; such patients have to pay about 40USD for an injectable course of antibiotics. Our excitement would therefore not be in a global map of AMR patterns but the action that will be taken in response to AMR. The planned surveillance therefore should be able to tell us the key drivers in the spread of AMR.
We know that acceleration of emergence and spread of the emergent strains of microbes is within the influence of health practitioners and consumers of health care. We are involved in the use and misuse of antimicrobial drugs and therefore accelerating the emergence of drug-resistant strains. Practitioners and consumers of health care can make a contribution to the fight against AMR by appropriately using antimicrobial drugs. This includes adherence to treatment guidelines by the health care practitioners and receiving and taking all medication as prescribed for the patients. This also includes avoidance of self medication by the community. The other intervention is about prevention of infection. If you avoid getting in contact with the microbes, then you will avoid the resistant ones as well. Prevention includes infection control, adequate sanitary conditions and appropriate food-handling.
Prevention of infection is more complex and may not be effectively enforceable by an individual. Of all options, therefore, the best way we could contribute to the fight against AMR is by respecting prescriptions. Health workers should prescribe in line with standard guidelines and Health care consumers should follow their prescriptions religiously.