The war vs. the abuse, misuse of antibiotics
For every bacterial infection we may have, popping an antibiotic (aka antibacterial, which is a type of antimicrobial) pill is like second nature to us. Literally translated as “opposing life,” antibiotics are so much a part of our lives. As modern medicine’s wonder drugs, antibiotics have nearly eradicated a lot of diseases like tuberculosis. However, their easy availability, mass production, and rampant use have led to abuse/misuse. This has so alarmed the World Health Organization that WHO now calls it a clear and present danger in a lot of countries all over the world.
When Antibiotics No Longer Work
So, what happens when these drugs suddenly stop working on those life-threatening infections?
When first-line drugs no longer work, doctors have to resort to second-line antimicrobials, which are not only more expensive, but also need to be monitored closely.
For the past many years, doctors have sounded the alarm on antimicrobial resistance (AMR), where infectious microorganisms, previously treatable by certain drugs, eventually become resistant to treatment. This brings us to the misuse of drugs as patients, not knowing any better, tend to self-prescribe or discontinue medication once they think they’re well enough, mainly because of financial constraints. Infections and diseases have also become more and more fatal that doctors are resorting to stronger antibiotics.
As can be gleaned from the review “Antimicrobial Resistance: Tackling a Crisis for the Health and Wealth of Nations” in 2014, there were some 700,000 cases of AMR in the world, and this number is expected to soar to 10 million by 2050.
To increase awareness on this urgent healthcare issue, MSD, in line with its advocacy of battling AMR, recently organized a multi-sectoral dialogue, bringing together leading experts on infectious diseases: Prof. Tony Korman from the Monash University in Australia, Dr. Rontgene Solante of the San Lazaro Hospital in Manila, and dancing Department of Health assistant secretary and official spokesperson Dr. Eric Tayag.
Tackling the Philippine Action Plan to Combat AMR: One Health Approach, the dialogue underscored the fact that AMR can cause “increased mortality rates, prolonged hospital stay, admission to the intensive care unit (ICU), and the spread of resistant microorganisms to other patients. Consequently, AMR can also translate to increased costs due to prolonged illness and hospitalization. Patients, then, become more at risk of nosocomial infections, which are even more difficult to treat. Further, the death rate of patients, who are treated in hospitals and have serious infections caused by resistant microbes, is estimated to be twice than that of patients with infections caused by non-resistant bacteria.”
Meet The 12 Families Of Bacteria
WHO recently published a list of bacteria for which new antibiotics are urgently needed. The catalogue includes 12 families of bacteria that pose the greatest threat to human health. This serves as a guide to promote research and development of new antibiotics, as part of WHO’s efforts to address growing global resistance to antimicrobial medicines. According to their urgency, the list is divided into three categories: critical, high, and medium priority.
According to WHO, “the most critical group includes multidrug-resistant bacteria that pose a particular threat in hospitals, nursing homes, and among patients whose care requires devices such as ventilators and blood catheters. This includes Acinetobacter, Pseudomonas, and various Enterobacteriaceae (including Klebsiella, E. coli, Serratia, and Proteus), which can cause severe and often deadly infections such as bloodstream infections and pneumonia.”
These bacteria have become resistant to a large number of antibiotics, including carbapenems and third-generation cephalosporins, the best available antibiotics for treating multidrug resistant bacteria.
On the other hand, the high and medium priority categories include other increasingly drug-resistant bacteria that cause more common diseases such as gonorrhoea and food poisoning caused by salmonella.
Back to the dialogue: It was noted that “countries, such as the Philippines, that currently have high malaria, HIV and TB cases, along with AMR, are expected to suffer more.”
What about microorganisms in animals? Microorganisms in animals may cause financial losses to farmers and affect consumers’ confidence in food safety, thus reducing the demand for these food products.
For one thing, the “One Health Approach” “recognizes the interdependence of the human, animal, environmental and economic sectors in determining the health impacts and considerations of a country.” It is only through this integrated approach that the growing problem of antimicrobial resistance can be solved.
According to the latest DOH report on the Antimicrobial Resistance Surveillance Program (ARSP) report in 2015, “organisms commonly involved in deadly human infections are responding less and less to antibiotics.” The report goes on to say, “The alarming fact is that these bacteria are not just becoming resilient to first-line antimicrobials such as fluoroquinolones and third-generation cephalosporins, but also to strong, last-resort antibiotics called carbapenems.”
Dr. Korman tackled cases of AMR in hard-to-treat, frequently-recurring, and life-threatening infections such as complicated urinary tract infection and complicated intra-abdominal infection (cIAI).
Treating these infections with carbapenems leads to increasing resistance. The patient may get well, but, at the same time, the development of carbapenem resistance in the infecting organism has been accelerated.
MSD addresses this problem by continuously innovating treatment options. Says Dr. Butch Recto, MSD medical director, “In a sense, microorganisms have been developing resistance to drugs faster than we humans are able to develop new drugs. This is the situation that we have to overcome by strengthened research and development.”
The dialogue called on everyone to do their part in battling AMR. The public can do its part by not resorting to self-prescription and antibiotic abuse.
Healthcare providers are also urged to actively participate in the government’s antimicrobial surveillance program, to monitor the presence of AMR in the country and guide doctors in handling infections more effectively and efficiently.
Are you aware of the fact that there’s a Philippine Antibiotic Awareness Week? In November last year, community membes came up with informational drives on AMR.
MSD was also one of top three winners of the “AMR Warriors” awards.
Dr. Recto concludes, “The battle against AMR is continuous and we cannot relent. It is difficult, but with concerted effort — from patients and doctors, to the government as well as the private sector — we can be optimistic of a world finally free from AMR.”
