Antibiotic resistance, emerging global threat to public health

At the turn of the century, the World Health Organization (WHO) estimated that infections accounted for 45 percent of deaths in Africa and South-East Asia. With infections responsible for 48 percent of premature deaths globally, bacteria cause a significant proportion of infections in Africa.

Unfortunately, resistance to antibiotics has undermined the idealistic hope that bacterial infection would cease to be an important cause of death and disease. Antibiotic resistance has increasingly compromises the outcome of many infections that were, until recently, treatable and remain the most common diseases in Africa. The abuse of antibiotics in medicine has long been known to foster the emergence of germs that are resistant to drug.

A new report by the WHO titled “Antimicrobial resistance: global report on surveillance,’ reveals that antibiotics resistance threat is no longer a prediction for the future; it has the potential to affect anyone, of any age, in any country across the globe.

Antibiotic resistance, when bacteria change so antibiotics no longer work in people who need them to treat infections, is now a major threat to public health.

The report revealed that resistance is occurring across many different infectious agents responsible for common, serious diseases such as bloodstream infections (sepsis), diarrhoea, pneumonia, urinary tract infections and gonorrhoea.

Key findings in the report show that resistance to the treatment of last resort for life-threatening infections caused by common intestinal bacteria, Klebsiella pneumoniae—carbapenem antibiotics have spread to all regions of the world.

K. pneumoniae is a major cause of hospital-acquired infections such as pneumonia, bloodstream infections, infections in newborns and intensive-care unit patients. In some countries, because of resistance, carbapenem antibiotics would not work in more than half of people treated for K. pneumoniae infections.

Resistance to one of the most widely used antibacterial medicines for the treatment of urinary tract infections caused by E. coli—fluoroquinolones—is widespread. In the 1980s, when these drugs were first introduced, resistance was virtually zero. Today, there are countries in many parts of the globe where this treatment is now ineffective in more than half of patients.

In the WHO African Region, a major gap in tracking of antibiotic resistance was experienced with data gathered in a limited number of countries. While it is not possible to assess the true extent of the problem with the data available, significant resistance is reported for several bacteria that are spread in hospitals and communities.

This includes significant E. coli resistance to third generation cephalosporins and fluoroquinolones—two important and commonly used types of antibacterial medicine. In some parts of the region, as many as 80 percent of Staphylococcus aureus infections are reported to be resistant to methicillin (MRSA), meaning treatment with standard antibiotics does not work.

Antibiotic resistance causes people to be sick for longer and increases the risk of death. For example, people with MRSA are estimated to be 64 percent more likely to die than people with a non-resistant form of the infection. Resistance also increases the cost of health care with lengthier stays in hospital and more intensive care required.

Onyebuchi Chukwu, minister of health, urged Nigerians to heed the warnings from the public health community about actions that contribute to antibiotic resistance. Chukwu explained that the germs that cause disease develop a defense against drugs because of the abuse of such drugs.

“This renders many of our drugs ineffective, for example those used against malaria and tuberculosis. People can help tackle resistance by using antibiotics only when prescribed by a doctor, completing the full prescription, even if they feel better and never sharing antibiotics with others or using leftover prescriptions. The time to act is now to ensure a healthier and better tomorrow,” the Minister advised.

Keiji Fukuda, WHO’s Assistant Director General on Health Security noted that without urgent, coordinated action by many stakeholders, the world is headed for a post-antibiotic era, in which common infections and minor injuries which have been treatable for decades can once again kill.

“Effective antibiotics have been one of the pillars allowing us to live longer, live healthier, and benefit from modern medicine. Unless we take significant actions to improve efforts to prevent infections and also change how we produce, prescribe and use antibiotics, the world will lose more and more of these global public health goods and the implications will be devastating,” Fukuda made in a statement to BusinessDay.

While some countries have taken steps in addressing the problem, every Nigerian needs to do more. Important actions include preventing infections from happening in the first place through better hygiene, access to clean water, infection control in health-care facilities, and vaccination to reduce the need for antibiotics.

Alexander Chiejina