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ANTIBIOTIC DEVELOPMENT AND GLOBAL INTERVENTION IN COMBATING THE EMERGENCE OF ANTIBIOTIC RESISTANCE

By Adeyemi Sylvester

INTRODUCTION

Antibiotics were the wonder drugs of the 20th century because of their  ability to kill and inhibit bacterial growth. In the pre-antibiotic era, the treatment of infectious diseases in human and animals was almost impossible. Besides the use of herbal medicines, there was no way out of the death sentence. That was until 1928, which  marked the beginning of  the antibiotic era when Sir Alexander Fleming discovered penicillin from the mold penicillium. After this breakthrough in medicine, came the emergence of antibiotics.

Resistance to antibiotics could either be natural due to inherent characteristics or acquired when  bacteria undergo evolutionary changes that transform their cells. These changes that lead to bacterial resistance to antibiotics are caused by both bacterial and human factors.

CAUSES OF ANTIBIOTIC RESISTANCE

Primary causes of antibiotic resistance include wrong dosage, inappropriate prescription, inaccurate regimen, mechanical ventilation, multiple underlying diseases, poor hand hygiene.

In animals, antibiotics are used at subtherapeutic doses to promote growth. At subtherapeutic doses, bacterial population develops resistant strains. In research studies resistant bacteria can be transmitted from animals to humans in three ways: by consuming animal products (milk, etc.) from close or direct contact with animals or other humans, or through the environment. In the first pathway, food preservation methods can help eliminate, decrease, or prevent the growth of bacteria in some food classes.

ROLE OF PHARMA SECTOR IN ANTIBIOTIC DEVELOPMENT

The pharma sector undoubtedly plays a vital role in developing newer medicines as resistance emerge. Since 1945, newer antibiotic were being discovered to compete with the evolving bacterial population. According to an article published in the journal Clinical Infectious Diseases in January 2009, only 5 of the biggest pharma companies –GlaxoSmithKline, Novartis, AstraZeneca, Merck and Pfizer still had antibacterial discovery programmes in 2008. This is because of the commercial impact it has on the companies. The return on investment is poor and treatment of bacterial infection is usually short course regimen so patronage begins to reduce as soon as the infection is cured. That’s why companies have stopped developing antibiotics.

However, the launch of every antibiotic has been and will be followed by resistance in the targeted bacteria. Therefore, there is a constant need to develop new agents to keep up with the acquisition of resistance among pathogenic bacteria.

As a way to encourage drug-development, private-public partnership should be embraced to curtail financial burden of obtaining newer antibiotics.

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GLOBAL ACTION PLAN AGAINST ANTIBIOTIC RESISTANCE

There have been increasing public calls for global collective action to address the threat. In 2014 WHO released preventive strategies to tackle resistance

The public can help tackle resistance by:

  • Using antibiotics only when prescribed by a health professional
  • Completing the full prescription, even if they feel better
  • Never sharing antibiotics with others or using leftover prescriptions

Health workers, including pharmacists, can help tackle the resistance issues by:

  • Enhancing infection prevention and control
  • Only prescribing and dispensing antibiotics when they are truly needed
  • Prescribing and dispensing the right antibiotic(s) to treat the illness

Policymakers and industries can help tackle the resistance by:

  • Strengthening resistance tracking and laboratory capacity
  • Regulating and promoting appropriate use of medicines
  • Fostering innovation and research and development of new tools
  • Promoting cooperation and information sharing among all stakeholders

On March 27, 2015, the White House released a comprehensive plan to address the increasing need for agencies to combat the rise of antibiotic-resistant bacteria.

The Action Plan was developed around five goals with focus on strengthening health care, public health, veterinary medicine, agriculture, food safety and research, and manufacturing. These goals, as listed by the White House, are as follows:

  • Slow down the emergence of resistant bacteria and prevent the spread of resistant infections
  • Strengthen national One-Health surveillance efforts to combat resistance
  • Advanced development and use of rapid and innovative diagnostic tests for the identification and characterization of resistant bacteria
  • Accelerate basic and applied research and development for new antibiotics, other therapeutics, and vaccines
  • Improve international collaboration and capacities for antibiotic resistance prevention, surveillance, control and antibiotic research and development

The following are goals set to meet by 2020.

In 2015, WHO started the World Antibiotic Awareness week from 16–22 November to improve global awareness, promote rational use, and prevent further instances of resistance.

On 22nd September 2016, at the UN Meeting, collaboration between approximately 70 heads of state and ministers of health and foreign affairs demonstrated overwhelming political support to combat AMR. After the meeting, UN  decided to focus on rectifying the startling level of under-investment in AMR-related research; and a major new commitment by 13 of the world’s largest pharmaceutical companies, including giants of the generics industry, to take concrete actions to reduce the development and spread of drug resistance.

Mr. Sylvester a recent pharmacy graduate of Igbinedion University Okada, Nigeria.

adeyemisylvester1@gmail.com

REFERENCES

  1.  Pechère JC (September 2001). “Patients’ interviews and misuse of antibiotics”. Clin. Infect. Dis. 33 Suppl 3: S170–3. 
  2.  Arnold SR, Straus SE (2005). Arnold SR, ed. “Interventions to improve antibiotic prescribing practices in ambulatory care”. Cochrane Database of Systematic Reviews (4): CD003539. 
  3.  Antibiotic Resistance – Linking Human And Animal Health: Improving Food Safety Through a One Health Approach Workshop Summary. Wegener, Henrik C. Washington (DC): National Academies Press (US); 2012
  4. Todar’s online textbook of bacteriology by Kenneth Todar phD
  5. Race against time to develop new antibiotics: Bulletin of the World Health Organization 2011,89:88-89
  6. The bacterial challenge:time to react  A call to narrow the gap between multidrug-resistant bacteria in the EU and the development of new antibacterial agents
  7.  “FACT SHEET: Obama Administration Releases National Action Plan to Combat Antibiotic-Resistant Bacteria”. whitehouse.gov. Retrieved 2015-10-30.
  8. WHO AMR newsletter 2016
  9. “WHO’s first global report on antibiotic resistance reveals serious, worldwide threat to public health” Retrieved 2014-05-02

University of Zimbabwe Students Uniting To Fight Antimicrobial Resistance

By Bakani M. Ncube

The University of Zimbabwe College of Health Sciences student association bodies came together, united by one vision and goal, to join in a global campaign to combat antimicrobial resistance from November 14th to 20th. The World Antibiotic Awareness Week was marked by the public, policy-makers, human and veterinary health professionals and student engagement through social media and local awareness-raising events around the world.

The World Health Organization (WHO) defines Antimicrobial Resistance (AMR) as the resistance of a microorganism to an antimicrobial medicine to which it was previously sensitive. Resistant organisms (they include bacteria, viruses and some parasites) are able to withstand attack by antimicrobial medicines, such as antibiotics, antivirals, and antimalarials. Standard treatments become ineffective, infections persist and may spread to others. AMR is a consequence of the use, particularly the misuse, of antimicrobial medicines. It develops when a microorganism mutates or acquires a resistance gene.

There is a grave need for this global campaign as antibiotic resistance has become one of the biggest threats to global health and it endangers other major priorities such as development. It is escalating to dangerously high levels in all parts of the world, compromising our ability to treat infectious diseases and undermining many advances that have been made in the field of health and medicine in the past decades. As a result of this, the WHO in May 2015, came up with a global action plan to tackle antimicrobial resistance that was endorsed at the World Health Assembly. It was supported by the Food & Agriculture Organization of the United Nations (FAO) and World Organization for Animal Health (OIE). The first objective of this plan was to ‘improve awareness and understanding of antimicrobial resistance through effective communication, education and training’.

The objectives of the campaign are to make antibiotic resistance a globally recognised health issue as AMR lead to failure in the standard treatment, resulting in prolonged illness and greater risk of death. This further increases the cost of health care as infections that have become resistant to first-line medicines will need the intervention of more expensive therapies. The longer the duration of illness and treatment, often in hospitals, increases health-care costs and poses a financial burden to families and societies. Antibiotics are a precious resource that cannot be taken for granted. They have allowed many serious infections to become very treatable and have saved millions of lives and there needs to be a worldwide change in behaviour if their effectiveness is to be preserved. With this in mind, the second objective is to raise awareness of the need to protect antibiotics through appropriate use. To illustrate the severity of the situation, about 440, 000 new cases of Multidrug-Resistant Tuberculosis (MDR-TB) emerge annually, causing at least 150, 000 deaths and Extensively Drug-Resistant Tuberculosis (XDR-TB) has been reported in 64 countries to date. Another aim of the World Antibiotic Awareness Week is to increase recognition of the role that individuals, human and animal health professionals, agricultural professionals and governments must all play in tackling antibiotic resistance. To sum up, the main goal is to encourage the change in behaviour and to convey the message that simple actions can make a huge difference.

Although antibiotic resistance can occur naturally, the process is being accelerated by a number of factors which has led to record high levels of antibiotic resistance. The current worldwide antibiotic resistance crisis has been due to over-prescribing and dispensing of antibiotics, the misuse of antibiotics by patients as well as the overuse and misuse of antibiotics in livestock, fish farming and on plants. The pharmaceutical industry is not developing new antibiotics, vaccines, diagnostics and therapeutic options at a quick enough rate and this has also led to the current AMR crisis as well as poor infection control in hospitals, clinics and farms. In certain areas of the country, the lack of toilets and proper sewage disposal has propagated antibiotic resistance.

We are calling on you, all of you, to aid in the reduction of antimicrobial resistance by only using antibiotics when they have been prescribed by a certified health professional, to always follow your health worker’s advice when using antibiotics, to never share or use leftover antibiotics, prevent infections by regularly washing your hands, handling food in a safe and clean manner, limiting contact with sick people, practicing safer sex and keeping your vaccinations up to date. In Zimbabwe, one of the challenges we face are patients demanding antibiotics even when the health worker says we do not need them and this is especially seen when patients seek antibiotics to treat a cold or flu.

Without urgent action, 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 and the benefits of advanced medical treatments such as chemotherapy and major surgery will be lost. Without effective antibiotics, an ever increasing list of infections such as pneumonia, blood poisoning, gonorrhoea and tuberculosis are becoming harder to treat. The emergence of AMR is a complex problem driven by many interconnected factors and a global and national multi-sector response is urgently needed to combat the growing threat of AMR. It is not too late to reduce the impact of antimicrobial resistance. Remember, no action today will result in no cure tomorrow.

Mr. Bakani is the Student Exchange Officer of Zimbabwe Pharmaceutical Students Association, a member of IPSF African Regional Office.