Anna Shimbulu & Frieda Shigwedha
Defence strategies are natural elements of any living organism for survival and include pathogens (disease-causing microbial organisms). The microbial organisms not only fight back when targeted, but also find new ways to survive. Their defence strategies are called resistance mechanisms.
Antimicrobials are medicines that target pathogens in humans, animals as well as plants to prevent and treat infections. They include antibiotics, antivirals, antifungals and antiparasitics.
Microbial organisms develop resistance to medicines naturally over time, usually through changes to their genetic material, a concept known as antimicrobial resistance (AMR). The consequence of AMR is that the medicines become ineffective and infections become increasingly difficult or impossible to treat.
The resistant organisms are found in people, animals, food, plants and the environment (water, soil and air). They can therefore spread between people and animals, including from food of animal origin.
AMR is increased and accelerated by various factors including, the misuse and overuse of the antimicrobials; lack of access to clean water; sanitation and hygiene for humans and animals; poor infection control practices in health facilities; poor access to quality and affordable medicines; lack of awareness and knowledge as well as lack of enforcement of legislation. AMR is a particular concern with antibiotics, especially with common infections such as urinary tract infections (UTIs), sepsis, sexually-transmitted infections and some forms of diarrhoea that have shown high rates of resistance. Therefore, the limited number of antibiotics available indicates that we are running out of effective options.
According to the data shared by countries to the Global Antimicrobial Resistance and Use Surveillance System, the rate of resistance to ciprofloxacin, an antibiotic commonly used to treat UTIs, had a wide range depending on the bacteria. For E. coli, it ranged between 8.4% - 92.9%, and 4.1% - 79.4% for K. pneumoniae.
Antibiotic-resistant TB strains (M. tuberculosis) threaten the progress in containing the global TB epidemic. The World Health Organisation (WHO) estimated that in 2018, there were about half a million new cases of rifampicin-resistant TB identified globally. The vast majority of those cases have multi-drug resistant TB, a form of TB that is resistant to the two most powerful medicines (rifampicin and isoniazid) used in TB treatment.
When infections can no longer be treated by first-line antimicrobials, repercussions include: more expensive medicines must be used; a longer duration of illness and treatment, often in hospitals; increased healthcare costs; as well as the economic burden on families and societies. In addition, medical procedures such as surgery, cancer chemotherapy and organ transplantation, which requires antibiotics to prevent as well as treat bacterial infections, could become risky.
Noting that AMR is a complex problem that requires a multisectoral approach, it is for this reason the “One Health” approach was established. This approach brings together multiple sectors and stakeholders that are engaged in human terrestrial and aquatic animal and plant health, food and feed production and the environment to communicate and work together in the design and implementation of programmes, policies, legislation and research to attain better public outcomes. This approach played a critical role in the development of our National Antimicrobial Resistance Action Plan (NAAP), which focuses on AMR surveillance, prevention, optimisation of the use of antimicrobial medicines, education, training and research and development as important factors which contribute to combating AMR nationwide. For the year 2021, the WHO has marked the week of 18 to 24 November as World Antimicrobial Awareness Week (WAAW) under the theme ‘Spread Awareness, Stop Resistance’. This week was dedicated to creating awareness around AMR.
The following are some of WHO recommendations that can be taken at all levels of society to reduce the impact and limit the spread of AMR resistance:
Only use antibiotics when prescribed by a certified health professional.
Never demand antibiotics if your health worker says you don’t need them.
Always follow your health worker’s advice when using antibiotics.
Never share or use leftover antibiotics.
Prevent infections by regularly washing hands, preparing food hygienically, avoiding close contact with sick people, practising safe sex, and keeping vaccinations up to date.
Prepare food hygienically: keep surfaces clean, separate raw and cooked food, cook thoroughly, keep food at safe temperatures, use safe water and raw materials.
Prevent infections by ensuring your hands, instruments, and environment are clean.
Only prescribe and dispense antibiotics when they are needed, according to current guidelines.
Report antibiotic-resistant infections to surveillance teams.
Talk to your patients about how to take antibiotics correctly, antibiotic resistance and the dangers of misuse.
Talk to your patients about preventing infections (for example, vaccination, hand washing, safer sex, and covering nose and mouth when sneezing).
Only give antibiotics to animals under veterinary supervision.
Do not use antibiotics for growth promotion or to prevent diseases in healthy animals.
Vaccinate animals to reduce the need for antibiotics and use alternatives to antibiotics when available.
Promote and apply good practices at all steps of production and processing of foods from animal and plant sources.
Improve biosecurity on farms and prevent infections through improved hygiene and animal welfare.
Ensure a robust national action plan to tackle antibiotic resistance is in place.
Improve surveillance of antibiotic-resistant infections.
Strengthen policies, programmes, and implementation of infection prevention and control measures.
Regulate and promote the appropriate use and disposal of quality medicines.
Make information available on the impact of antibiotic resistance.
* Shimbulu & Shigwedha are medicines information pharmacists at the Therapeutics Information and Pharmacovigilance Centre under the Namibia Medicines Regulatory Council Secretariat