November 30, 2022

How wrong prescription, misuse of antimicrobial drugs fuel resistance

… as scientists collaborate to tackle menace

By Chioma Obinna

With increasing misuse of antimicrobial drugs, medical experts have raised the alarm over increasing deaths associated with antimicrobial resistance, AMR, across the world and Nigeria inclusive.

Currently, findings by the World Health Organisation, WHO, show that Antimicrobial Resistance, AMR, otherwise known as drug resistance is currently posing a threat to public health as it is projected to cause over 10 million deaths globally by 2050, with a large part of it occurring in sub-Saharan Africa.

While antimicrobials are agents used to prevent, control and treat infectious diseases in humans, animals and plants, AMR occur when bacteria, viruses, fungi and parasites no longer respond to antimicrobial agents such as antibiotics, fungicides, antiviral agents and parasiticides.

As a result of drug resistance, antibiotics and other antimicrobial agents become ineffective and infections become difficult or impossible to treat, increasing the risk of disease spread, severe illness and death.

Unfortunately, experts say the misuse of antimicrobials is not limited to those misused by people in communities but also those rightfully prescribed in clinical settings.

According to WHO, the global and regional burden of AMR remains alarming with an estimated 700,000 deaths annually, but sub-Saharan African countries bear the heaviest burden of resistant bacterial infections. Why AMR occur According to the Chairman, Healthcare Providers Association of Nigeria Lagos State chapter, HCPAN,  Pharm.

Abiola Paul Ozieh,  the main cause of AMR is the misuse and overuse of antimicrobial medicines. “In our clime misuse of antimicrobials especially antibiotics is so rampant.

“For example, self-limiting conditions like diarrhoea are often treated with antibiotics like tetracyclines. This is a wrong practice and such leads to the emergence of resistance strains rendering the drug unsuitable for any reasonable clinical use.

“It should be noted that these antimicrobials are also used in a manner that prime resistance development because some people never finish their course of antibiotics, antibacterials, and   antifungal.”

She explained that a course of antibiotics to be used for five days may be used for only two days thus resulting in suboptimal doses which prepare for AMR.

“It is regrettable that the misuse of antimicrobials is not limited to those misused by people in communities but also those rightfully prescribed in clinical settings. One sour example of antimicrobial resistance is the multi-drug resistant Mycobacterium tuberculosis (mDR-TB). HIV cases have been worsened by the mDR-TB.”

She blamed easy access to prescription medicines, the preponderance of open drug marketplaces all over Nigeria, ineffective implementation of enabling regulations and weak enforcement as some of the factors fuelling AMR in Nigeria.

“Of course, the public health literacy level is also very low which makes people to “prescribe” medicines to their neighbours and share medicines though they have not been consulted by a registered medical doctor or counselled by a registered pharmacist or health care Professional.”

She stressed the need for Public Health enlightenment to counter the development of resistant strains to the available antimicrobials, adding that, fewer new antimicrobials are now being developed; hence, all hands must be on the deck to preserve the antimicrobials currently in use.

Paul-Ozieh called on Nigerians to ensure that they get a proper prescription for antibiotics from qualified health professionals before taking them. In the views of the Director-General of the Nigeria Centre for Disease and Control, NCDC, Dr. Ifedayo Adetifa, AMR is a pandemic waiting to happen, hence the need for urgent interventions to halt AMR.

He said in Nigeria, 7 out of 10 persons in the community access antibiotics outside licensed health facilities or pharmacies, while many patients in the hospitals are overprescribed antibiotics that have a higher risk of bacterial resistance selection.

He expressed fear that if nothing is done urgently to educate Nigerians on the health hazards like cancers, allergies, mutations etc., associated with abusing antimicrobials – antibiotics, antifungals, antivirals, and antiparasitics, many infections like pneumonia, sepsis among others, which could be easily treated using antimicrobials could become untreatable, hence causing deaths.

In a report entitled: “Global Perception of Antimicrobial Resistance (AMR) by Sepsis Alliance, experts note that through overuse and misuse of antimicrobial drugs, the bacteria, viruses, fungi, and parasites that cause infection and sepsis in humans can more quickly evolve to become resistant to drugs.

“For Dr Olufemi Lawani of the Department of Microbiology, University of Ilorin Teaching Hospital, UITH, healthcare professionals and patients are guilty of the emergence of AMR while regulators regulated poorly and the government on its part compromised access to standard healthcare. He stressed the need for stakeholders to upscale their roles towards drastic reduction in what he described as a ‘medical menace’.

For WHO Director-General, Dr Tedros Adhanom Ghebreyesus, AMR is one of the most urgent and complex challenges of our time, and because it is not as dramatic as a pandemic, a war or a humanitarian emergency, it doesn’t attract the same attention.

Stakeholders’ commitment However, in line with the WHO call for a drastic response, a global anti-infective leader like Pfizer, with its pioneering work on penicillin in the 1940s, has a long and proud heritage of addressing evolving infectious disease challenges such as AMR. As one of the original signatory companies of the Declaration on Combating Antimicrobial Resistance (AMR) in 2016, Pfizer has remained committed to the development of innovative medicines and vaccines as well as solutions that go beyond medication. The company currently offers patients one of the industry’s largest and most diverse portfolios of anti-infectives – more than 80 medicines – including therapies that help address areas of greatest unmet medical need, such as the treatment of Gram-negative bacterial and invasive fungal infections.

According to Pfizer, their commitment to research and development (R&D) is focused on both the treatment and prevention of infections caused by difficult-to-treat resistant pathogens and would continue to evaluate opportunities and partnerships to expand our R&D pipeline to ensure we address the evolving medical needs of people and physicians in this critical area of infectious disease.”

Currently, the company is working closely with the entire infectious disease community to address AMR through active stewardship to ensure patients receive the correct anti-infective, according to independent guidelines, only if needed and in the right direction.

Also to mitigate the errors in clinics, the pharmaceutical giant is also committed to innovative surveillance tools to help physicians better understand current resistance patterns, facilitate anti-infective development, proper use, and access to medicines and vaccines as well as ensure that in manufacturing it applies responsible manufacturing practices that minimise impact to human health and the environment.

Committed to combating AMR, the company’s R&D focused on difficult-to-treat resistant pathogens as they continue to evaluate opportunities and partnerships to expand their R&D pipeline to ensure they address the evolving medical needs of patients and physicians in the critical area of infectious disease.

Also in an effort to stop AMR, Pfizer sponsored one of the largest AMR surveillance programmes in the world – The Antimicrobial Testing Leadership and Surveillance (ATLAS), a database that provides free, rapid access to anyone to extensive data on emerging bacterial and fungal resistance patterns and sensitivity to antibiotics.

To further explore ways to evolve resources to meet the changing needs of the infectious diseases community and halt the spread of resistant pathogens, in April 2020, Pfizer evolved the ATLAS website platform from an industry-recognised antibacterial surveillance platform to a broader antimicrobial surveillance platform.