AS was highlighted during the World Antimicrobial Resistance Awareness Week that was observed recently (Nov 18-24), antibiotic resistance has touched alarming proportions, and policymakers need to wake up to the worsening situation. The menace has to be tackled at local, national and global levels.
Antibiotic resistance occurs when bacteria become resistant owing to overuse of antibiotics. Antimicrobial resistance (AMR) has been called one of the greatest threats to human health that has significant public health consequences unless we all come together and work to keep the remaining antibiotics effective through their rational use.
Overuse of antibiotics in humans and animals causes AMR that is now a major public health crisis. Scientists have warned that the world is on the cusp of a post-antibiotic era, with extremely resistant bacteria that are also called superbugs. An estimated 700,000 deaths occur each year worldwide due to AMR.
Antibiotic resistant infections will kill an estimated 300 million people worldwide — more than the current annual death toll of cancer — by 2050 unless proper and urgent action is taken by all concerned. Antimicrobials are also used selectively in poultry, plant agriculture and commercial fish and seafood farming. Contamination of human food of animal origin — meat and milk — with drug-resistant bacteria may get transferred to consumers.
With a rise of bacteria resistant to antibiotics in the last decade, many bacterial infections are becoming resistant to the most commonly prescribed antibiotic treatments. The Covid pandemic worsened the tendency towards bad prescriptions on the part of healthcare professionals and self-medication by laypersons. This led to indiscriminate use of unnecessarily powerful broad-spectrum antibiotics.
Every time a person takes antibiotics, sensitive bacteria are killed, but the resistant ones are left to grow and multiply. Repeated and improper uses of antibiotics are primary causes of the increase in drug-resistant bacteria in humans and animals. It is beyond doubt that misuse of antibiotics has actually jeopardised the utility and effec-tiveness of essential drugs.
In Pakistan, the use of antibiotics is alarmingly high both in humans and animals. Approximately 70-90 per cent of patients with viral upper respiratory tract infections (URTIs) are prescribed antibiotics unnecessarily that are mostly self-limiting. Resistant infections due to these superbugs are causing thousands of deaths and hospitalisation each year.
Since the Covid pandemic, global antibiotic use has escalated and is likely to increase AMR and hamper global and national efforts. Vaccines can prevent infections and reduce antibiotic overuse that reduces AMR. Use of different available vaccines is one of the best ways to control AMR. Among good examples are the rotavirus, typhoid, pneumonia and measles vaccines that are part of the national Expanded Programme for Immunisation (EPI) for children aged 0-23 months. There are also some vaccines in the market for general use that can help in this regard.
The National Action Plan for combating AMR includes the core strategy. What we need to do is to implement the plan in its right spirit. In Pakistan, the anticipated benefits of typhoid conjugate vaccines (TCVs) for mitigating the burden of resistant typhi can be huge. Thus, we need to improve the coverage of all current and future vaccines to decrease the AMR burden.
Improved education and awareness for uptake of vaccines, prudent antibiotic use and infection control measures to combat AMR are necessary to ensure the safety of the population. We must resolve to act urgently by taking all available steps that will curtail AMR.
Prof Ejaz A. Khan
Islamabad
Published in Dawn, December 11th, 2023
