By  Sola Ogundipe

Alarmed by the growing threat of antimicrobial resistance as a result of the increasing use of antibiotics to treat even the most common ailments, medical doctors and other physicians have been cautioned against the indiscriminate prescription of antibiotics.

File photo: Fake drugs about to be destroyed.

“doctors should stop prescribing antibiotics when they are not needed.”

Speaking in Mumbai, India, during the 102nd Indian Science Congress, on the global perspective on challenges in medical research, he stated that one of the current issues globally is the increasing use of antibiotics and the increasing resistance to antibiotics.

“If that keeps growing, we are going to be in real trouble. Patients also insist to the doctors to prescribe antibiotics for things like cold, even when the doctor knows that the antibiotics is not going to be of any assistance at all. So the doctor shouldn’t give them to the patient. But people tend to prescribe when the patient demands it.

“It is a very difficult situation,” Warren, who hails from Adelaide in Australia, asserted. “It is not a disaster yet, but could easily become one.”

Antibiotics are the most frequently prescribed drugs among hospitalised patients and the reported concerns about the continuous indiscriminate use has gained international prominence.

Global action

At the 67th World Health Assembly, WHA, in May 2014, the WHO was requested to develop a draft global action plan to combat antimicrobial resistance, to be submitted to the 68th WHA in May 2015.

“When we started on our journey, scientific and technological tools were not advanced. Science believed that bacteria couldn’t grow in stomach, good biopsies were rare, and there were no clinical specimens.

“Gastritis was not understood well by the medical fraternity. But we refused to be discouraged, kept experimenting with determination and after years of dedicated hard work, discovered the bacterial strain,” he said.

“It was a quite a miracle and opened new vistas in discovering treatments for Gastritis and peptic ulcers for making the life of human beings more productive and healthy,” Warren stated.

Untreatable gonorrhoea and ‘staph’

For years, health authorities have expressed concerns that certain infections, such as Sexually Transmitted Infections like gonorrhoea are getting dangerously close to being untreatable. If untreated, gonorrhoea can cause serious complications, including infertility and life-threatening ectopic pregnancies.

“Gonorrhoea used to be susceptible to penicillin, ampicillin, tetracycline and doxycycline — very commonly used drugs,” said Jonathan Zenilman, an infectious diseases expert at Johns Hopkins.

But one by one, each of those antibiotics — and almost every new one that has come along since — eventually stopped working. One reason is that the bacterium that causes gonorrhoea can mutate quickly to defend itself.

“A lot of this is occurring not because of treatment for gonorrhoea but overuse for other infections, such as urinary tract infections, upper respiratory tract infections and so forth,” Zenilman said.

Recently there was evidence that gonorrhoea had started to become resistant to cefixime, and the CDC has declared that doctors should immediately stop using it.

Scientists are searching for new combinations of antibiotics that might work. And officials are pushing for new weapons that might stay one step ahead of gonorrhoea and the growing list of antibiotic-resistant infections.

Another issue is the unwanton cases of the Urinary Tract Infections,UTI, other wise known as “Staphylococcus”or “Staph”. Most symptomatic patients usually indulge in indiscriminate usage of antibiotics before consulting the physicians when they could no longer control the symptomatic situations.

Physicians on the other hand usually treat the patients with broad spectrum antibiotics without any microbiological investigations.

Such widespread indiscriminate use and inappropriate prescription of antibiotics in the treatment of gonorrhoea, and UTIs are significant contributing factors to the emergence and spread of bacterial resistance to the commonly used antimicrobial agents.

WHO AMR Report 2014

A report by the World Health Organisation, WHO, on prescription of antibiotics says resistance to antibiotics poses a “major global threat” to public health. Warning of the possibility of Antimicrobial Resistance, AMR, the WHO described it as a phenomenon that threatens the effective prevention and treatment of an ever-increasing range of infections caused by bacteria, parasites, viruses and fungi.

In its report entitled Antimicrobial Resistance Global Report on Surveillance 2014, the WHO observed that antimicrobial resistance within a wide range of infectious agents is a growing public health threat of broad concern to countries and multiple sectors.

In the report, Dr Keiji Fukuda, Assistant Director-General Health Security, stated that increasingly, governments around the world are beginning to pay attention to a problem so serious that it threatens the achievements of modern medicine.

“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,” he noted.

The Report warns that “Without action, we are headed for a post-antibiotic era in which common infections and minor injuries can one-again, kill.

“Use antibiotics only when prescribed by a health professional. Complete the full prescription even if you feel better   and never share antibiotics with others or use leftover prescriptions,”it concludes.

The Report, produced in collaboration with WHO Member States and other partners, provides as accurate a picture as is presently possible of the magnitude of AMR and the current state of surveillance in 114 countries. It highlights a major gap in knowledge about the magnitude of the problem and information needed to guide urgent public health actions. ABR is complex and multidimensional.

One important finding of the report, which will serve as a baseline to measure future progress, is that there are many gaps in information on pathogens of major public health importance.

The report makes a clear case that resistance to common bacteria has reached alarming levels in many parts of the world indicating that many of the available treatment options for common infections in some settings are becoming ineffective.

It identifies strengthening of global AMR surveillance as critical as it is the basis for informing global strategies, monitoring the effectiveness of public health interventions and detecting new trends and threats.

It is expected that as WHO, along with partners across many sectors moves ahead in developing a global action plan to mitigate AMR, the report will serve as a baseline to measure future progress.”

Policy guidelines

In April 2011, Former Minister of Health Professor Onyebuchi Chukwu had furged against actions that contribute to antibiotic resistance. The theme for that year’s World Health Day was entitled Combat Antimicrobial Resistance in line with global significance and requiring urgent and concerted action.

In the view of Nigeria Country Representative for WHO, Dr David Okello, inappropriate use of medicines include acts such as not finishing the course of prescribed medicine.

“It is also inappropriate when a healthcare professional prescribes antibiotics when they are not needed, for example for the common cold, or when persons diagnose and treat themselves – known as self medication. Unauthorised vendors of drugs also contribute to the problem.”

Nigeria has developed policy guidelines that provide a framework of actions that can be taken to reduce development of antibiotic resistance.

Chief among them is to develop a national plan covering strengthening of disease surveillance and diagnostic laboratory capacity; facilitation of access to quality essential medicines; regulation of the use of medicines and promotion of their rational use.

The regulation of the use of antimicrobials in animal husbandry, prevention and control of infectious diseases and finally, recommendations for fostering innovation and development of new tools are also included.

It is estimated that by 2050 the global cost of AMR will be up to $100 trillion and will account for 10 million extra deaths a year. If ever there is need for a reminder of what a public health catastrophe looks like, this has to be it.

Recommendation

However, in reality this can be difficult to achieve, particularly in countries where antibiotics are freely available or there is lack of sanitation and healthcare is limited.” In a study entitled “Prevalence and Antibiotic Resistance Pattern of Methicillin-Resistant Staphylococcus aureus carried out at the Orthopaedics Department of the Ahmadu Bello University Teaching Hospital (ABUTH), Zaria, it was showed that Methicillin-resistant Staphylococcus aureus, MRSA, continues to pose a threat to the hospitalised patients, especially those with bone and wound infections.

Results show a possibility of misuse and abuse of antibiotics among the populace even before going to hospital.

In its recommendation, the team urged government and medical personnel, especially those involved in the daily prescription of commonly used antibiotics, to pay greater attention to the situation, calling for continuous education on cleanliness and the dangers of the misuse of antibiotics.

In another study entitled “Antibiotic Prescription Pattern and Cost at University of Ilorin Teaching Hospital, Ilorin, Nigeria,” by T.M. Akande , M. Ologe and G.F. Medubi, published in the International Journal of Tropical Medicine, 2009, Volume: 4, Issue: 2, it was discovered that antibiotics prescription habits of doctors in developing countries calls for concern.

The recommendation was that a lot of money can be saved if policies are formulated and promoted on rational antibiotics prescription in developing countries like Nigeria.

The antibiotic utilisation and prescribing patterns in a Nigeria generally shows that even where correct knowledge of antibiotic prescribing pattern is evident, it is not followed in practice.