By Maris Sellah
Antibiotic resistance is one of the biggest threats to public health worldwide, food security and development. It can affect anyone of any age, in whatever country.
Antibiotic resistance occurs naturally, but misuse of antibiotics in humans and animals is accelerating the process. The resistance occurs when bacteria become resistant to the active ingredients in these medicines.
Data from the World Health Organisation (WHO) shows that a growing number of infections such as pneumonia, tuberculosis, gonorrhoea, and salmonellosis are becoming harder to treat as the antibiotics used to treat them become less effective.
“Antibiotic resistance leads to longer hospital stays, higher medical costs, lowere productivity and increased mortality,” said WHO Representative to Kenya Dr Rudi Eggers. “Bacteria, not humans or animals, become antibiotic-resistant. These bacteria may infect humans and animals, and the infections they cause are harder to treat than those caused by non- resistant bacteria.”
Dr Eggers was speaking during the World Antibiotic Awareness Week marked on November 13, at the Kenyatta National Hospital (KNH).
The 2017 theme was “Seek advice from a qualified health professional before taking antibiotics”. He said that antibiotic resistance is rising to dangerously high levels in all parts of the world with new resistance mechanisms emerging and spreading globally, threatening our ability to treat common infectious diseases.
The bacteria that cause gonorrhea, for instance, are evolving rapidly to evade new classes of antibiotics to treat the infection. This puts women particularly at greater risk of developing complications such as pelvic inflammatory disease, ectopic pregnancy and infertility, as well as an increased risk of HIV. “Where antibiotics can be bought for human or animal use without a prescription, the emergence and spread of resistance is made worse,” Dr Eggers said.
“Similarly, in countries without standard treatment guidelines, antibiotics are often over-prescribed by health workers and veterinarians and over-used by the public.” Dr Eggers retaliated that without urgent action, we are heading for a post-antibiotic era, in which common infections and minor injuries can once again kill.
This comes as a joint effort research by US and Kenya biologists exposed a high prevalence of antibiotic resistant bacteria in Western parts of Kenya due to over-use of antimicrobial agents. The research was conducted by the US Naval Research Laboratory (NRL), US Army Medical Research Directorate- Kenya (USAMRD-K), Kenya Medical Research Institute (KEMRI), and University of Washington.Using a technology – NRL-developed microarray – the researchers detected over 200 different antibiotic resistance genes from bacteria sampled from intestinal tract of healthy individuals and ailing patients from Western Kenya.
The samples were collected from eight Kenyan clinics including district hospitals of Kisumu, Kisii, Migori, and Homa Bay. “We discovered a high prevalence of bacteria strains resistant to commonly used antibiotics,” said Dr Chris Taitt, research biologist at NRL – Center for Bio/Molecular Science and Engineering.
“These results suggest that there is selective pressure for the establishment and maintenance of resistant strains. This is potentially due to agriculture and prophylactic use of antibiotics and further suggests the need for more effective public health policies and infection control measures than those currently implemented.”
Dr Taitt said that while it is important for improvements to global health, an understanding of the types and prevalence of antibiotic resistance in under-characterized regions, such as the Great Horn of Africa, can additionally benefit deployed military personnel in making risk assessment for exposure to, and treatment of, resistant infections.
Dr Eggers said that the world is facing a medical crises that can be resolved only with such joint action. “Each one of us has to play their role, to avoid that we go back to a state where antibiotics fail even for minor infections or surgeries,” he said.
The WHO has, however, commended the Kenyan government through the Ministries of Health and Agriculture for taking an early leadership of the antimicrobial resistance (AMR) agenda both locally and internationally.
Locally, the two ministries have designated AMR focal points, and they have rallied their stakeholders, and other sectors around a One Health platform for addressing AMR in Kenya. Establishing the National Antimicrobial Stewardship Advisory Committee (NASAC) has facilitated the multi-sectoral approach on AMR Internationally; Kenya has been an important voice and ally on AMR, at the World Health Assembly (WHA), United Nations General Assembly and other multinational fora.
The WHA in May 2015, for instance, endorsed a global action plan on antimicrobial resistance, including antibiotic resistance. The global action plan aims to ensure prevention and treatment of infectious diseases with safe and effective medicines. Kenya has successfully developed the Policy and National Antimicrobial Prescribing Survey (NAPS) on the prevention and containment of AMR, through systematic process that entailed a situation analysis, the identification of gaps and the corrective actions.
“Adapting the NAPS to the context of devolution and the specific governance arrangements in all sectors, has helped to ensure that these policy documents are aligned to the country context,” said Dr Eggers. “Because of Kenya’s success to-date, other countries are now learning from the Kenya experience in the development of the NAPS. We trust that Kenya will continue in this trend throughout the implementation. This is truly important. Let us not fail to address this problem immediately and comprehensively.”
The WHO Regional Director for Africa, Dr Matshidiso Moeti said Africa lacks adequate data to clearly grasp the scope and scale of the problem. Dr Moeti said WHO in the African Region has made the fight against antibiotic resistance a top health priority, and is working with countries, including Kenya to implement the Regional Emergency and Security Strategy.
Research and development is the cornerstone of new, effective antibiotics to save lives. However, since the 1980s there have been very few new antibiotics. Incentives such as public-private partnerships are urgently needed to stimulate the development of new antibiotics.
Dr Moeti said antibiotics are in danger of losing their effectiveness due to over-prescribing and dispensing by health care professionals, misuse by patients such as not following the advice of healthcare professionals, overuse in farming and animal husbandry, poor infection control, and a lack of new antibiotics.
“From being miracle life-savers, antibiotics are becoming ineffective. Nothing less than global health security is at stake when antibiotics are misused,” said Dr Moeti. She said however that there is hope that this trend can be reversed through strong country leadership to drive action across society, from the public, to the healthcare industry, to governments at local, national and international levels.
Dr Moeti added: “Critical steps include close tracking of antibiotic-resistant infections, regulating the appropriate use of quality medicines, and warning the public about the dangers of misuse of antibiotics.”
“Misuse of antibiotics puts us all at risk. Taking antibiotics unnecessarily speeds up antibiotic resistance, making infections more difficult and expensive to treat. Therefore I advise everyone to think twice, seek advice and always consult a qualified health professional before taking antibiotics.”