Can we afford to lose effective drugs?


Two plaques coated with drug-resistant bacteria are seen at the Health Protection Agency in north London, Britain. Reuters

Antimicrobial resistance (AMR) can be known to consumers and patients simply as drug resistance. However, it is in reality an imminent threat to global health security that threatens to derail efforts to meet the goals of the 2030 Agenda for Sustainable Development.

Simply put, AMR develops when microbes – bacteria, viruses, fungi, and other parasites – undergo genetic changes that make it unresponsive to antibiotics meant to kill them. The problem that needs to be pointed out is that AMR has rendered many drugs ineffective against many diseases.

Given its huge impact, in 2015, a global action plan to tackle the growing problem was approved at the 68th World Health Assembly. Since then, the World Health Organization has celebrated Global Antimicrobial Awareness Week from November 18 to 24 each year.

Since Alexander Fleming discovered the antibiotic penicillin in 1929, antimicrobials have saved millions of lives around the world. But many of these drugs are now at risk of becoming ineffective due to antimicrobial resistance.

According to conservative estimates, AMR kills 700,000 people each year. However, based on the latest WHO estimates, the actual number could be much higher.

Tuberculosis (TB) bacteria, for example, are becoming resistant to many antibiotics, fueling cases of drug-resistant tuberculosis, which are more difficult and expensive to treat and cure, and threaten overall progress in disease control.

In Thailand, 1,400 cases of drug-resistant tuberculosis were discovered last year alone, according to the latest WHO Global Tuberculosis Report.

AMR is also threatening to roll back the progress Thailand, if not the entire region, has made in the fight against malaria.

Resistance to chloroquine, the drug commonly used to prevent and treat malaria about four decades ago, has been reported across the Greater Mekong subregion, which includes Thailand, Myanmar, Cambodia, Vietnam. and Laos.

Now experts fear the cases will reappear, as there have been reports of artemisinin resistance as well.

Thailand has made commendable progress in rolling out life-saving antiretroviral therapy for people living with human immunodeficiency virus (HIV). But antiretrovirals may become less effective due to the emergence of drug-resistant HIV, warned Dr Ishwar Gilada, of the Board of Directors of the International AIDS Society (IAS).

“The prevalence of drug-resistant fungal infections is increasing; and generalized resistance to ciprofloxacin, which is commonly used to treat urinary tract infections and pneumonia, has been reported. No wonder the WHO has declared antimicrobial resistance as one of the top 10 threats to global health. added Dr Gilada.

Although AMR is ultimately an evolutionary process, humans contribute to its increased rate. WHO said factors such as poor infection control in clinical, veterinary and food production settings, as well as limited access to clean water, sanitation and hygiene were the main drivers of RAM.

The use of poor-quality drugs and the irrational use of antibiotics not only among people, but also among livestock and agriculture.

In fact, one study found that while only 6.9% of Covid-19 patients it surveyed actually suffered from a concomitant bacterial infection, 72% were prescribed antibiotics. Unfortunately, the negative impact of such irrational use of antibiotics will only manifest itself in the future.

Not just humans

Humans abuse antibiotics not only in the public health sector, but also in agriculture and animal husbandry.

Sub-therapeutic doses of antibiotics are frequently used to promote growth in livestock and also as a preventative action against possible infection among herds of animals. Citrus fruits are regularly sprayed with antibiotics like streptomycin and tetracycline and antifungals are used by the flower industry to increase production. These are just a few examples of how antimicrobials are misused in animal husbandry and agriculture.

Elizabeth Tayler, WHO technical officer at the Joint Tripartite Global Secretariat for Antimicrobial Resistance, warned that the more antimicrobials we use, the greater the chance that resistance will develop.

In addition, drug resistant antimicrobials are entering the environment. Large residues of antibiotics have been found in effluents from intensive farming areas and hospitals, all of which end up in rivers where thousands of people bathe and drink, increasing the spread of drug-resistant diseases. .

Can we afford to lose drugs?

While the call to accelerate the research and development of new treatments rightly receives more attention, we simply cannot afford to lose drugs that we know are working because of AMR.

WHO experts advocate effective infection control and appropriate sanitation in all settings as the key to controlling antimicrobial resistance. This will help control the spread of infection, which in turn will reduce the use of antimicrobials.

Other mechanisms include regulations to ensure that antimicrobials are not sold without a prescription and are prescribed only when needed.

The fight against AMR requires that different sectors – food, veterinary medicine, human health and environmental protection – work together under a “One Health” approach.

Without a coordinated multisectoral response across the spectrum, disease management will become more difficult and food security will be compromised.

Joseph Thomas, who heads the World Health Organization (WHO) Antimicrobial Stewardship and Awareness program, Joseph Thomas said last week that we need more political commitment and action at national levels community and individual to end indiscriminate use of antimicrobials and put in place strict infection control measures.

He urged the world to act quickly, saying the cost of inaction has already become very high.

Let us all heed the call for awareness to stop the resistance.


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