Everyone’s Critical Role in Fighting AMR

Everyone’s Critical Role in Fighting AMR

by Teresa May B. Bandiola, RPh, CPh, MSPharm (C)

Antimicrobial resistance (AMR) pertains to the ability of microbes, such as bacteria, fungi, viruses, or parasites to grow despite the presence of antimicrobials that normally kill or inhibit their growth, rendering these drugs ineffective against previously treatable infections. AMR is a broader term than antibiotic resistance, which is specifically the resistance of bacteria to antibiotics (also known as antibacterial, if synthetically made) that are used to treat the infections they cause. Since antibiotics are the commonly used antimicrobials, antibiotic resistance has become a more popular term than antimicrobial resistance.

Microorganisms that develop AMR are sometimes called “superbugs.” Their resistance occurs naturally over time, through genetic changes. However, this phenomenon can also be aggravated by other factors, largely through the misuse and overuse of antibiotics, both in humans and animals.

Unfortunately, AMR is now an alarming public health concern that requires urgent and coordinated action across all sectors of society. The World Health Organization (WHO) and countries around the world are beginning to be threatened by the possibility of reaching a post-antibiotic era, where ordinary infections and minor injuries, which have been non-threatening for years, can become fatal once again. AMR can also increase health care cost and could endanger the economy.

Early in 2016, researchers, for the first time, have found in the United States a 49-year-old Pennsylvania woman carrying a strain of the bacterium Escherichia coli resistant to the drug colistin, the antibiotic of last resort when all other drugs fail to clear up an infection. Then a second case was reported in a patient in New York, where a resistant strain of E. coli has also been identified. However, this strain was said to be collected from the patient during a hospital stay in 2015, rendering it the earliest known case of this kind in the US.

It is evident that bacteria are becoming resistant faster than new antibiotics are being developed, so the challenge that the humankind has to face now is to continue designing or re-designing strategies to combat antimicrobial resistance at the soonest possible time. These include the introduction of new and often expensive antibiotics, the use of antibiotic combinations, and efforts to avoid the misuse and abuse of antibiotics.

All countries need national action plans on AMR. In the Philippines, the Department of Health (DOH) has already created Antimicrobial Resistance Surveillance Program since 1988. However, AMR continues to be aggressive and spread globally, and just like the rest of the world, we also need to respond.

In our communities, there has been a wrong practice where we have been using antibiotics for self-medication when in fact, they require medical consultation and diagnosis. Also, it is common that these drugs are bought in drugstores over the counter, without prescription from a licensed physician. This was happening for decades, but with the ceaseless reminders of the Philippine Pharmacists Association (PPhA) and the orders and advisories enforced by the Food and Drugs Administration (FDA) to Filipino pharmacists and drugstore owners, this irrational dispensing of medications was corrected. A lot of people think that antibiotics, that are supposedly used against bacteria, can be used for viral infections like colds or flu so pharmacists, as front-line practitioners, need to debunk this misconception and take a more proactive role in educating patients and raising awareness about the proper antibiotic usage and the development of resistance. Worse, the public thinks that antibiotics are like vitamins that can be used anytime they want to.

The general public plays a very crucial role in fighting AMR. We should know that it is wrong to self-medicate and it is important to take the appropriate antibiotic dosage and complete the course of therapy even though we already feel better. It is also important not to share antibiotics with others or use any left-over antibiotics because they may not be the correct antibiotic and would not lead to a full period of treatment. Keeping vaccination up to date must also be taken into consideration because some recommended vaccines protect against bacterial infections, such as diphtheria and pertussis (whooping cough). Regular washing of hands, maintaining healthy lifestyle, and avoidance of “experimental sex” matter, as well.

In the hospital setting, there are programs dedicated to improve antibiotic use, commonly referred to as “Antibiotic Stewardship Programs (ASPs).” Aside from helping clinicians optimize the treatment of infections and reduce unwanted effects associated with antibiotics, these programs have also been proven to significantly reduce antibiotic resistance.

Unfortunately, resistant microbes know no borders, and they can also be present in animals, particularly in farm animals and domestic pets. Majority of livestock breeders does not only use antibiotics to treat or prevent infections but also to enhance animal growth and production, which is wrong. And because the usage of antibiotics in animal husbandry is often profit-driven rather than health-oriented, the development of antibiotic resistance is higher. This can then enter the food chain and transmission begins. Pets at home are no exceptions. There are also possibilities that antibiotics can be misused in pets for viral or parasitic infections, or improper use or under-dosing of medication can be committed by the owner himself. All these can pose danger to antibiotic resistance. And it can go to the environment and be spread between people and animals and from people to people.

Because of the involvement of agriculture to AMR, the Malacaῆang Palace issued Administrative Order No. 42 series of 2014 with the aim to create an Inter-agency Committee for the Formulation an Implementation of a National Plan to Combat AMR in the Philippines, wherein the Department of Health and the Department of Agriculture are to act as the co-chairs. Here, the committee functions to collaborate, formulate, develop and implement, and oversee the national plan for the prevention and control of AMR as well as promulgate guidelines, rules and regulations, and impose possible penalties and sanctions for violations.

Although there are many efforts coming from the government and various health sectors, it is critically important that everyone of us must cooperate. We are all in this together. We have to act now before the treatment of all types of infection is… nothing!

***

A licensed pharmacist, a self-published author of a fantasy book series, a pharmacy journalist, and a graduate student at the University of Santo Tomas, Teresa May B. Bandiola, RPh, CPh, MSPharm (C) is taking her break from teaching at a university and currently pursuing her thesis on dengue disease.