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Dr. Ofrin – Pic by Eshan Dasanayake

The 21st millennium, the new age of scientific and technological advancements, come with a major glitch. Common infections and minor injuries have once again become fatal as the efficacy of antimicrobial drugs gradually lessens and give rise to a world-wide spread of antimicrobial resistance (AMR).

AMR is the situation where antibiotics, antipatasitics and antifungals which are collectively referred to as antimicrobials, loses their effectiveness against certain micro organisms, mainly due to micro organisms developing a resistance for the particular drug.

World Health Organisation, Regional Director for Health Security and Emergencies, Dr Roderico Ofrin, in an exclusive interview with Nation said that new medical discoveries could be the demand of the future.

“The concern is that medicines for regular infections, such as infections on urinary tract, common cough, cold and pneumonia are not as effective as before,” he warned.

Currently, gonorrhoea has become untreatable in several countries. Resistance has spread to certain antibacterial drugs for urinary tract infections caused by E.coli to first-line drugs to treat infections caused by Staphlylococcus aureus and to last-resort drugs for life-threatening infections caused by common intestinal bacteria all over the world.

Some 20.5% of previously treated TB cases have now become multidrug-resistant tuberculosis MDR-TB while extensively drug-resistant TB (XDR-TB) has been identified in 100 countries, although this is believed to be under reported. There is multidrug resistance to certain forms of malaria and a rise in HIV drug resistance. These drugs may even become ineffective.

By 2012, influenza A viruses were resistant to frequently used drugs. There is severe antibiotic resistance in bacteria that cause urinary tract infections, pneumonia and bloodstream infections, globally. A high percentage of hospital-acquired infections are caused by methicillin-resistant Staphylococcus aureus (MRSA) or multidrug-resistant Gram-negative bacteria.

According to Dr Ofrin, awareness is one of the most important weapons in battling
antimicrobial resistance. He lists a few of the must-knows for everybody, which includes the fact that antimicrobial resistance has manifested as a consequence of poor prescription practices and poor behaviour of patients.

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“People have a tendency to buy antibiotics from chemists even when they don’t need them. If the cough is viral that may get self-healed. What happens is that when you use antibiotics you start testing the micro organism against the medicine. The micro organisms are smart. They start developing a resistance against the drug in order to fight that,” he says.

In a way, it is a collective misbehaviour. There are chemists selling without the prescription, there are people self-medicating themselves with what they feel is a more powerful antibiotic or when they are prescribed an antibiotic by the doctor, they do not complete the full course. “If you are prescribed an antibiotic for five days, three times a day, you have to complete the full course,” he says.

Antibiotics are medicine against bacteria. The prescription of antibiotics for viral infections contributes to AMR.

“Antibiotics are not effective against virus. Most people don’t know this. This is the first misperception. When people don’t find medicine effective they say it’s ineffective,” explains Dr Ofrin.

In a case like this, the existing bacteria becomes resistant to the antidote against them. Bacteria behave in a certain way that they could decode this in their protein synthesis to develop resistance.

“The more you expose them to the antibiotics unnecessary, they don’t die off, they just find a way to become more resilient and survive,” he elaborates.
Therefore, this abuse of antibiotics should be avoided at all costs”, said Dr. Ofrin. “What one should do first is rest, take fluids and if it’s a sore throat, gargle with salt. Consulting a doctor is also a good idea”.
AMR spans beyond human health. The irrational use of antimicrobials in animals, especially those bread for food, harbour resistance.

“In a way you will be ingesting anti biotics when you eat meat,” he contends. “It is a whole cycle. Regulation of control of antibiotics in the animal industry is very important to battle the spread of resistance of the micro organisms to the antibiotics.”

“For example it is believed antibiotics act as a growth promoter when it is given to chickens. As a result the chicken is considered to be fleshier. However, this is a misconception as science has actually provided evidence that it does not contribute to the growth. In the Netherlands they have regulated the use of antibiotics for animal husbandry and this did not reduce the production. In Thailand, they brought in legislature not to use certain antibiotics in the animal industry. South Korea has regulated more than half of the usual listed antibiotics for animals,” Dr. Ofrin emphasized.

The World Health Organisation campaigns in November every year to address the problem of antimicrobial resistance and the presence of a very good regulatory authority is important according to Dr. Ofrin who says chemists issuing antibiotics without prescriptions should be stopped and the prescriptions handed out by doctors should meet certain protocols.

“First line antibiotics have to be prescribed before higher level drugs. The third line of drugs should only be used if none of the others answer. What generally happens is that patients request doctors for strong drugs because they do not want to stay away from work. The doctor also consents because he doesn’t want to lose that patient,” Dr. Ofrin revealed.

Another important aspect in controlling antimicrobial resistance is infection prevention and control. Individuals themselves should take responsibility against actions contributing to antimicrobial resistance. It is important to adhere to habits such as hand washing before and after meals, after using the toilet and after visiting hospitals. It is the first barrier against any bacteria touching you. There is also the need for a reliable surveillance system to monitor antimicrobial resistance and antimicrobial use across sectors.

“It is a worthy investment. If you can’t account what you are trying to address, then you are hitting blindly,” says Dr Ofrin. “There is need to advocate behavioral changes as well as policy changes. All these have to happen across three main sectors. Namely, the food sector, animal sector and human sector”.

Research process does not happen overnight. There is a research gap in developing new antimicrobials. That’s where the danger is. There is more resistance to the existing antimicrobials and no new drugs are produced at the same time.

“The consequential losses are huge. The treatments for regular diseases have become more expensive. In some of these resistant bugs, the chances of being cures are reduced by half. If there is a superbug, with no effective medicine, that would be catastrophic. So you have to go to a higher level. This is costlier for the patient, the hospital stay is longer and that infection may have transmitted elsewhere,” says Dr Orfin.

“Right now, we don’t have the drugs to combat resistant bugs. This will result in a higher number of deaths and simple infections will be untreatable or become more costly. It is the bottom line for AMR.”

The change of behavioural patterns might prolong the efficacy of the existing
antimicrobials. Currently, there is no other type of remedy.

“In 2015, the WHO initiated a global action plan to combat AMR. Aligned with these action plans each country should have their own action plan. Sri Lanka already has a multi sectoral coordinating body, that is actually developing the plan. This coordination has to happen before more reports of patients with cases resistant to existent drugs. There is an essential list of medicine that can be imported. At the same time the usage of this list should be controlled by legislation,” opines Dr. Ofrin.

“Momentum has picked up against AMR globally. That is the one health approach which believes we can’t think of human health without thinking about animal health. Where did avian flu come from?” he asks.

AMR would be discussed by all the world leaders at the forthcoming UN assembly later this month.

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