Concerns Grow Over Antimicrobial Resistance

Antimicrobial resistance (AMR) is a global concern now. AMR arises when bacteria and other microorganisms against which antibiotics are used adapt to the antibiotics and become unsusceptible to them, rendering them ineffective. As per the World Health Organisation, AMR is growing worldwide and new resistance mechanisms are emerging and spreading rapidly all over the world. With a surge in AMR, it has been difficult to treat even common infectious diseases like pneumonia.

It is estimated that AMR causes 700,000 deaths per annum. The figure is estimated to go as high as one million by 2050 if effective measures are not taken to prevent AMR. So AMR has reached global proportions. Bacteria have a natural ability to develop resistance against antibiotics. So AMR cannot be completely eliminated. Such microbes develop resistance against mostly front-line antibiotics and sometimes second-line microbes as well. Since penicillin was used to save people’s lives during and after World War II, the use of antibiotics has grown at an accelerated rate so much so that it has become a headache now. 

Overuse of antibiotics

The whys and wherefores of AMR are varied: misuse and overuse of antibiotics, self-medication, use of antibiotics as growth promoters, lack of well-equipped health facilities, use of antibiotics with a lower dose of the active ingredient and lack of legislation or poor implementation of such legislation. Poor animal husbandry practices, inadequate prevention and control measures against infectious diseases, lack of awareness of good management practices and lack of judicious use of antibiotics are the major reasons for AMR in the animal sector. 

AMR is baneful to both individuals and nations. AMR pushes up patient care costs. Patients have to stay hospitalised for a longer period of time because AMR prolongs the duration of cure. To cope with AMR, front-line medicines have to be replaced by more potent and expensive medicines. This causes an economic burden on patients. AMR also contributes to increasing morbidity and mortality rates. At a national level, poor countries have to invest huge amounts of money in the health sector. Recent estimates have it that economic damage from uncontrolled AMR could be as high as that of the 2008 financial crisis. This points to the gravity of the issue. 

AMR is also a problem in Nepal. Nepal is an agrarian country. Animal husbandry, part of agriculture, is widely practised in the country. Livestock farming is estimated to chip in 13 per cent to the national gross domestic product and 27 per cent to the agricultural gross domestic product. With demand for livestock products growing, livestock industries are also growing and expanding far and wide. It is surmised that livestock farming is growing at 1.23 per cent per annum in the country. 

Livestock farmers use antimicrobials to prevent or treat animal diseases. They also use them as growth promoters. As most of them have an inadequate knowledge about how to use antimicrobials, they end up using them haphazardly. Sometimes, they resort to self-medication. All this has contributed to creating an environment for AMR to grow. AMR has become a global issue. In the last few years, international agencies have developed strategies and guidelines for evidence-based interventions. The WHO, Food and Agriculture Organisation (FAO) and the World Organisation for Animal Health (OIE) have developed strategies, global action plans and recommendations. Such interventions are designed to be encapsulated in the national action plans on AMR of countries around the world. 

It may be noted that not all countries can adopt all of the above recommendations; however, they can commit themselves to some priority measures and implement them. They can focus on the most feasible measures and make legislation to implement them. Concerted efforts on the part of countries are required to fight AMR, which is growing at an alarming rate. 

At the UN General Assembly high-level meeting on AMR held in 2016, the participating countries pledged to develop national plans based on the WHO global action plan on AMR as endorsed by the health ministers of countries at the UN Health Assembly held in 2015. This shows the growing worldwide concern about AMR. However, a global treaty on AMR has not been reached yet. Such a treaty could be an effective tool for reducing the misuse and overuse of antibiotics in humans and animals. And it could also be helpful in securing the effectiveness of antibiotics. In the present-day scenario, the need for having such a treaty in place is acutely felt.

Prudent use

Antibiotics are life-saving drugs. They should be prudently and optimally used. However, the haphazard use of such drugs has invited trouble. To prevent the misuse and overuse of such drugs as well as their use in self-medication, awareness should be developed in all concerned. Medical practitioners and hospitals can play a crucial role in preventing the haphazard use of antibiotics. There is a proclivity on the part of some doctors for prescribing antibiotics even for diseases that can be treated without antibiotics. They prescribe antibiotics for quick cure, something patients greatly desire. 

Medical practitioners should prescribe antibiotics only for those who need them, and that too in correct quantities. Antibiotics with a lower quantity of the active ingredient are not to be prescribed. At the same time, it should be ensured that antibiotics reach those who need them. Treatment with inadequate antibiotics could increase both morbidity and mortality rates, besides giving rise to a higher infection rate. It follows that all the people concerned, the medical community, the government and other stakeholders, should act in tandem to steer clear of the AMR problem. 

(Maharjan has been regularly writing on contemporary issues for this daily since 2000.)