Antimicrobial Resistance: No Action Today, No Cure Tomorrow

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Until the discovery and availability of antimicrobials in the 1940’s, persons frequently died as a result of infectious diseases. Today, few of us could imagine living in a world without powerful antimicrobials that allow us to live longer and healthier lives.

Though not a new problem, resistance to these drugs, known as antimicrobial resistance (AMR), has the potential to render useless the current arsenal of medicines, and forms the basis of this year’s Thursday, April 7, World Health Day theme, Antimicrobial Resistance: No Action Today, No Cure Tomorrow.

AMR is the resistance of a microorganism to an antimicrobial medicine, to which it was previously sensitive. These organisms, (bacteria, fungus, viruses and some parasites) can withstand attack by antimicrobial medicines, such as antibiotics, antivirals, and antimalarials. Consequently, standard treatments become ineffective and infections persist and spread, in some instances leading to fatalities.??????????????????????

Director of the Barbados Drug Service (BDS), Maryam Hinds, explained that AMR, in most cases, was a consequence of the abuse or the misuse of antimicrobial medicines and resistance developed when a microorganism mutated or acquired a resistant gene.?? "If this phenomenon continues unchecked, many infectious diseases risk becoming uncontainable and could derail progress made towards reaching the health-related United Nations Millennium Development Goals for 2015," she said.

According to the World Health Organization (WHO), the use and misuse of antimicrobials in human medicine and farming over the past 70 years have increased the number and type of resistant micro-organisms, causing death, suffering, disability, and higher health care costs.??

For instance, some 440,000 new cases of multidrug-resistant tuberculosis (MDR-TB) emerge annually, causing at least 150,000 deaths and Extensively Drug-Resistant Tuberculosis (XDR-TB) has been reported in 64 countries to date.

Ms. Hinds noted that AMR was a serious problem that "strikes at the core of infectious disease control" and had the potential to halt, and possibly roll back progress in this area. However, resistance can be contained through careful and appropriate antibiotic use, even though AMR was a natural response of microbes. She underlined, however, that in Barbados there was a national commitment to a comprehensive and coordinated response to the way antimicrobials are selected, and placed in the Barbados National Drug Formulary, a comprehensive and coordinated response for the pharmaceutical sector, with clear accountability, research and development on new products as well as strategies to plan for evidence-based interventions, should the need arise.??

Staff at the Ladymeade Reference Laboratory have also received training in the detection of HIV drug resistance, and staff of the Public Health and Queen Elizabeth Hospital Laboratories were trained in antimicrobial testing and monitoring at the Caribbean Epidemiology Centre CAREC in 2009.??
The BDS head disclosed that the ???first line’, or more commonly used antimicrobials, were made more available to the public, while the availability of ???second line’ and other high-end antimicrobials were restricted in the general community.?? "This is achieved by having protocols governing prescribing and limiting the number and type of these agents that are freely available.??

However, the Specially Authorised Drug programme of the Barbados Drug Service does allow for antimicrobials to be made available in the hospital and other health care settings, where there is a need to prescribe a more potent antimicrobial," Ms. Hinds added.

Pharmacist at the Black Rock Polyclinic, Cynthia Brathwaite, pointed out that patients can also contribute to AMR.

"For example, when persons use antibiotics to treat a viral infection such as the common cold, though they are specifically for bacterial infections; AMR can occur.?? Also, when individuals decide to treat themselves for what they perceive to be an infection and purchase antibiotics without a doctor’s prescription, or even when a patient does not take their medication as prescribed, -?? in doing this, they are in danger of not getting the effective dose for the number of days required to kill or ???disarm’ the organism.?? All of this opens the way for the organism causing the infection to become so familiar with the medication, because it has been so widely used, that when the medication is taken, it no longer works.

"The organism has now become resistant to the antimicrobial therapy or/medicine.?? The result is a person carrying a disease-causing organism in their bodies for longer periods, increasing the risk of exposure to others and the subsequent spread of diseases that are difficult to treat," Ms. Brathwaite explained.

The growth of global trade and travel, allow resistant organisms to spread worldwide within hours, and so on World Health Day this year, the WHO will appeal for an intensified global commitment to safeguard the medicines used today to treat infectious diseases for future generations.

A call to action will be issued to halt the spread of AMR by introducing a six-point policy package for all countries to combat antimicrobial resistance.??This will include policy-makers/planners, the public, practitioners, pharmacists and the pharmaceutical industry.??

Each year, World Health Day is observed to mark the founding of the WHO and a key health issue is chosen by the directing and coordinating authority for health within the United Nations system, to encourage persons of all ages to coordinate events to highlight its significance.??The day provides a unique opportunity for communities from across the world to come together for one day to promote actions that can improve our health.

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