MOST of us would at some point have been prescribed antibiotics for an infection.
Have you ever stopped before completing the course or taken antibiotics even when you didn’t need to or consumed those prescribed for someone else or for a different infection?
Your actions may seem harmless but its practices such as these which are contributing to bacteria which is resistant to antibiotics.
Antimicrobial resistance (AMR) occurs when bacteria find a way to resist the effects of antibiotics, enabling them to survive and multiply.
Consequently, medical treatments become ineffective and infections caused by these “superbugs” start to spread.
AMR is now a huge problem globally, resulting in 700,000 deaths annually and estimated to reach 10 million by 2050.
It has the potential to affect people at any stage of life, in any country, as well as the healthcare, veterinary and agriculture industries, making it one of the world’s most critical public health problems and Malaysia is not spared.
BEATING THE BUG
“We are seeing people die every day from antibiotic resistant infections and that’s a fact. It’s not something that’s coming but is already here,” says Datuk Dr Christopher Lee, head of infectious diseases for the Ministry of Health and Hospital Sungai Buloh.
Dr Lee explains that at any one time, in the Intensive Care Units (ICU) of hospitals in the country, whether public or private, there would be patients infected with antibiotic resistant bacteria.
In Malaysia, doctors have already seen patients infected with colistin-resistant bacteria.
Dr Lee says colistin is the “last resort” antibiotic used by doctors. There are no other options after that. Last year, there were five such infections and four patients passed away because they couldn’t be treated.
“If we don’t get this right, it’s only going to get worse and I am very worried.”
If no solution is found adds Lee the consequences of AMR could be devastating. Minor infections and injuries could become life threatening and serious infections such as pneumonia could become impossible to treat.
Many routine medical procedures could become too risky because of the risk of becoming infected while in hospital by a multi-drug resistant pathogen.
One way to combat the misuse of antibiotics which is contributing to this problem is for patients to have a conversation with their doctors about antibiotic usage.
Dr Lee says always ask and clarify whether antibiotics are really necessary when one is prescribed a course of the medicine.
And never demand for antibiotics because one assumes it will help one get better faster.
Doctors too need to ask themselves whether antibiotics are really necessary before they prescribe the drug to a patient and whether the patient will truly benefit from it.
Dr Lee says generally, most people consume antibiotics for upper respiratory tract infections but 90 per cent of all sore throats are caused by viruses and not bacteria.
And since antibiotics are ineffective against viruses, in many cases they are being used unnecessarily.
The same applies to ailments such as the common cold or flu which are also viral infections. Antibiotics would be ineffective in treating these conditions.
USE WISELY
Antibiotics changed the world and if we look at the history of medicine, antibiotics played a critical role in terms of ensuring mortality from infections dropped drastically says Dr Lee.
“But now, it’s a case of the more we use, the more we stand to lose.”
Antibiotics are powerful medicines but they are not a “cure all” stresses Associate professor Dr Syafinaz Amin Nordin, a clinical microbiologist and secretary of the Malaysian Society of Infectious Diseases and Chemotherapy.
We don’t need to use antibiotics every time we fall sick she explains. Antibiotics fight infections caused by bacteria and they either kill bacteria or stop it from growing and there are different types of antibiotics for different types of bacteria and infections.
When antibiotics are taken unnecessarily or misused, it will kill the good bacteria in our body and we need these good bacteria to digest food, give us nutrients and to protect us from harmful bacteria which cause bacterial infections.
Bacteria she adds are tiny organisms which can reproduce independently. They are around us and inside our bodies but only a small per cent actually cause infections.
But bacteria are “smart”. Whenever we take antibiotics, in response to the antibiotics, bacteria will try to adapt and change and evolve into something which is resistant to commonly used antibiotics.
This will therefore reduce or eliminate the effectiveness of antibiotics and as a result, these bacteria can continue to survive, multiply and even spread to other bacteria and other people.
“When humans face challenges and want to survive, they will try to adapt and become resilient and that is also what bacteria do when we consume antibiotics. They want to survive so they become resistant.”
Many people also think that our bodies become resistant to antibiotics which is a misconception. The ones that become resistant to antibiotics are the bacteria.
Syafinaz says whenever we are not well, instead of trying to treat the symptoms ourselves, it’s important to seek medical advice so a doctor can determine the type of infection we have and advise whether antibiotics are necessary.
We must ensure that antibiotics are prescribed and used appropriately she adds.
When someone is ill and the doctor suspects it could be a bacterial infection, he will first take a sample from the patient and send it to the laboratory. This will help identify the bacteria that is causing the infection and identify which antibiotics would be effective in addressing that particular bacteria.
Without effective antibiotics, the success of major surgery and even chemotherapy for cancer would be compromised says Syafinaz.
AMR also increases the cost of healthcare with lengthier stays in hospitals and more intensive care required.
“The key message is use antibiotics judiciously, only when necessary and use as directed by doctors.”
THE GROWING THREAT
IN 2016, 490,000 people developed multi-resistant Tuberculosis (TB) globally and drug resistance is also starting to complicate the fight against HIV and malaria as well.
A growing number of bacteria now have higher resistance rates against antibiotics, with some as much as 61 per cent. This means there is a 61 per cent possibility that the given antibiotic would not be effective in patients receiving treatment.
The devastating effect of these resistant bacteria on patients is both alarming and significant. These infections pose a significant public health and economic burden for our healthcare system.
Antibiotics are important medicine and have been in use for the past 70 years to treat various bacterial infections but the world is now facing a large and ever growing problem due to infections caused by bacteria that are increasingly resistant to existing antibiotics says Azwar Kamarudin, director of corporate affairs for Pfizer Malaysia.
Azwar adds that rates of antibiotic resistance will continue to rise if effective control measures are not adequately implemented and if antibiotics continue to be misused or used inappropriately.
But the good news is that there is hope for us to stem the tide of resistance but we need to act now and act aggressively to control the rates of resistance.
“The fight against superbugs is a joint effort. It not only requires, industry players, governments and policy makers and healthcare professionals but also the general public to join forces to slow the growing public health threat of antimicrobial resistance.”
FIGHT SUPERBUGS
IN addition to efforts being undertaken by the infectious disease community, there are things individuals can do every day to help prevent the development and mitigate the spread of AMR.
*Don’t take an antibiotic unless needed and only when prescribed by a certified healthcare professional.
*When prescribed an antibiotic, don’t miss doses and do finish the course of medication. Take exactly as instructed by your doctor.
*Never take antibiotics prescribed for someone else or prescribed to you for a different infection.
*Keep vaccinations up to date for you and your family as it reduces the chance that you’ll catch an infection that needs to be treated with an antimicrobial.
*Antibiotics – which target bacteria – are ineffective in treating the common cold, which is most often caused by a virus.
Source: Pfizer
MYTHS AND FACTS ABOUT AMR
Myth: Antibiotics are effective against all infections.
Fact: Antibiotics only work on pathogens which are sensitive to them.
Myth: AMR occurs when the body becomes resistant to antibiotics.
Fact: It’s the bacteria themselves which develop resistance to standard treatment, not the human body.
Myth: It’s good to stop taking antibiotics as soon as you feel better to minimise the risk of resistance.
Fact: Take the course for as long as prescribed, even when one feels better.
Myth: Antibiotic resistance is only a problem for people who take antibiotics frequently.
Fact: Anyone can become infected by multi-drug resistant bacteria.
Myth: There isn’t anything I can do to stop the spread of AMR.
Fact: Everyone has a role to play.
Myth: I live in a country where AMR is not a great concern so I don’t have to worry.
Fact: It’s an issue no matter where you live because of globalisation.
Source: Pfizer