ANTIMICROBIAL RESISTANCE: A PUBLIC HEALTH CRISIS THAT MANY ARE NOT AWARE OF

HAVE YOU EVER THOUGHT THAT BY POPPING BUG-BUSTING PILLS YOU WOULD BE EXPOSING YOURSELF TO HEALTH THREATS?

Over the past decade, physicians have been prescribing antimicrobial drugs to treat infections caused by microbes such as bacteria, viruses, fungi and parasites. Like all organisms on our planet defensing and adapting to survive, these microbes adapt to resist antimicrobials, in order to endure. This adaptation results in Antimicrobial Resistance (AMR) where those infectious microbes no longer respond to such drugs, even the ones that previously treated them effectively.It was estimated in the World Economic Forum that death-related to AMR is 700,000 cases annually. This death toll is projected to reach 10 million by the year 2050.AMR makes infections persist longer and even irresponsive to antimicrobials, which consequently increase the burden of infection economically and socially. Antimicrobial-resistant germs lead to extended hospital stay, complicated illness, more intensive care and sometimes are impossible to be treated leading to morbidity and mortality.Currently many major health problems are threatened as a result of AMR such as tuberculosis, malaria, HIV and influenza. Another leading type of resistance that is prevalent in most countries all over the world is resistance to antibiotics. Patients who suffer antibiotic resistance have worse outcome than patients who are non-resistant to antibiotic strains.

“Antibiotics are a very serious public health problem for us, and it getting worse. Resistant microbes outstrip new antibiotics”- Anthony Fauci

CAUSES OF AMR

AMR can happen naturally due changes within the microbe itself. Microbes can mutate genetically, pick up better gene from another microbe and/or change their characteristics (phenotypic change) to survive antimicrobial agents such as antivirals, antifungals, antibiotics, antiprotozoals, anthelmintic, etc.Another source that exacerbates AMR is the people’s misuse and overuse of antimicrobials.

This misuse can emerge by different ways such as: 

• Imprecise diagnosis: Physicians prescribe frequently broad-spectrum antimicrobials rather than narrow-spectrum ones. They are very concerned to give a treatment that has more chances of success, so that they would be perceived as good physicians and win more patients. 

• Empirical antimicrobial prescribing is very prevalent even if it is medically unnecessary and with no microbiological evidence. They tend to prescribe antimicrobials based solely on clinical presentation and prescribing familiarity and/or experience; even when they are uncertain of the exact microbe causing the infection. They are prone to ask for culture only when the broadest antimicrobial failed to improve their patient condition. Generally, culture is rarely requested for a first line antimicrobial.

• Inapt use:Patients tend to take antimicrobials with no prescription and/or overuse Over The Counter (OTC) ones. Having antimicrobial drugs available without prescription combined with poor awareness is a tide we need to diminish. It is very common that patients misuse certain antimicrobials for wrong indication such as using antibiotics for viral flu and cold infections.

It is also frequent that patients discontinue the adequate prescribed dose of the antimicrobial once their symptoms disappear or they feel better. Not finishing the prescribed dose creates a Darwinian battle posing a serious threat as it could leave the microbe in the body growing stronger. 

Additionally, patients demand physicians to prescribe a strong medicine for a quick cure. Many of them perceive antibiotics as one quality drug that would satisfy that. Thus, pushing their physicians to prescribe one, even if it is not needed. 

Agricultural use: Bad farming practice involves growing livestock in dirty crowded conditions and incorporating antimicrobials in their diet to avoid illness. Nevertheless, antimicrobials are given to healthy livestock to promote its growth in shorter time and produce more meat; thus, attaining more profit. 

It is assumed that 70% of global antibiotic consumption is used in farming. This consumption rate is expected to escalate; in order to meet the high meat intake demand we are facing nowadays. Consuming meat and poultry that have been pumped with antimicrobials accelerates the evolution of resistant microbial strains, while simultaneously causing unknown health risks.Moreover, antimicrobials are sometimes added to pesticides so that crops can fight diseases. Crops can also get contaminated by water or soil that have animals’ waste. 

In-hospital use:High doses of antimicrobials are usually prescribed to severely ill in-patients even if it’s unnecessary. Many physicians perceive infection control are substandard in hospitals; therefore, they prescribe antibiotics as prophylactic. This amplifies the risk to AMR as hospitals are already an infectious environment, where diseases usually spread. 

“The more we look at a drug resistance, the more concerned we are. It basically shows us that the end of the road isn’t very far away for antibiotics”- Tom Frieden

AMR PREVENTION MEASURES

Antimicrobials can be lifesaver in fighting infections, yet it is pivotal to commit to antimicrobial stewardship to combat malpractice; otherwise, AMR would remain wildfire taking people’s wellbeing and life. People need to take matters in their own hands by changing their attitude and behavior when it comes to antimicrobial consumption. It is fundamental to take action that lessen unnecessary massive use of antimicrobials; such as:

- Raising patients’ awareness on proper antimicrobial use:Patients should not share antimicrobials, use left overs from previous prescriptions or self-prescribe OTC antimicrobials without seeking medical advice.

- Ensuring full-prescribed course intake, even if symptoms are subsided:Breaking the course allows remaining microbes to survive and develop resistance.

- Encouraging good antimicrobial prescribing practice:Patients should not push their physicians to prescribe antimicrobials if not needed. 

- Using proper diagnostic and microbiological evidence: Proper diagnose and selective effective treatment are vital to avoid the impact of incorrect choice of antimicrobials; which jeopardizes patients’ outcomes. Patients should ask their physician for tests before taking an antimicrobial.

- Adapting in-patients’ safety strategies within the hospitals to control infections:Sustaining high hygiene level, appropriate antimicrobials use and adequate infection control practices mitigate the risk of AMR.

- Consuming food from safe sources:Consumers should seek organic products that were produced without antimicrobial growth promotors. 

- Ensuring safe food practices:Safe food preparation and handling are essential for protection against AMR foodborne infections.

- Maintaining routine immunization:This is key to halt the infections from happening at the first place. Vaccines protect against infections; thus avoiding antimicrobials use for treatment.

REFERENCES:

CDC (2019). Antibiotic resistance threats in the United States.WHO(2018). Antimicrobial resistance and primary health care.World Economic Forum (2018). The global risks report. 13th Edition.