Anti- Microbial Resistance is a new threat - Seeker's Thoughts

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Wednesday, 1 May 2019

Anti- Microbial Resistance is a new threat

Misuse and overuse of antimicrobial medicine could lead to devastating infectious disease outbreaks in the coming decades. There have been various reports about the threats anti- microbial resistance (AMR). 

In 2016, 490 000 people developed multi-drug resistant TB globally, and drug resistance is starting to complicate the fight against HIV and malaria, as well according to the WHO’s report.
The AMR will kill an extra 10 million people in a year worldwide, that is more than the deaths caused by cancer in 2050, if actions are not taken.
Not only death, AMR will damage the economy as catastrophic as the 2008-2009 global financial crisis, if no action is taken.
The report published by United Nation’s adhoc body said in May, 2019 that by 2030, microbial resistance could force up to 24 million into extreme poverty.
Death-caused-by-AMR

Currently, at least 700,000 people die each year due to drug-resistant diseases, including 230,000 people who die from multidrug- resistant tuberculosis. More and more common diseases, including respiratory tract infections, are untreatable; lifesaving medical procedures are becoming much riskier and food system is increasingly precarious.
What is AMR?
Drug resistance or Antimicrobial resistance (AMR) develops when microbes, including bacteria, fungi parasites, and viruses, no longer respond to a drug that previously treated them effectively.
death-occurred-by-disease

What are the most affected areas for AMR?
According to Mr. O’Neil, who is best known for his economic analysis of developing nations and their growing importance in global trade, the impact of AMR is going to be more in Brazil, Russia, India, China, Mexico, Indonesia, Nigeria and Turkey.
In Nigeria by 2050, more than one in four deaths would be attributed to drug resistant infections while India would see an additional two million lives lost every year.
Certainly, the anti-microbial-resistance will not only have health burdens but it will have economical and social impact as well.

What is the certainty of developing AMR?
Scientists and various reports have been published by WHO, United nations etc, and experts seem more certain about drug resistance than the climate change.
The group of United Nations ad hoc interagency coordinating group on Antimicrobial Resistance showed concern and calls for immediate action to avoid this major health crisis in May, 2019.
Report highlighted – non communicable conditions like heart disease and stroke are the greatest killers of human worldwide, while infectious diseases like Tuberculosis, MRSA – methicillin-resistant staphylococcus aureus, and malaria are becoming more resistant to the medications used to treat them.
There are some issues will be faced due to AMR by people: -
-         Some infections being harder to control and staying longer inside the body.
-         A high risk of disease spreading.
-         Longer hospital stays, increasing the economic and social costs of infection.
-         A greater chance of fatality due to infection.
-         A significance concern is that AMR could lead to a post-antibiotic era in which antibiotics no longer work.
-  common infections and minor injuries that became straightforward treat in the 20th century could again become deadly due to AMR.
Infectious diseases are becoming harder to treat, and hospitals are becoming riskier places to pick them from.
 
AMR 
Why does AMR spread?
Antibiotic resistance develops naturally in bacteria. However, our actions can increase resistance developing and spreading. This can happen:
1.       when human and animal health professionals over prescribe antibiotics
2.      when people don’t take antibiotics as directed
3.      due to poor hygiene and a lack of infection prevention and control e.g. not washing hands properly
4.      due to people travelling around the world, spreading resistant bacteria.
Therefore, while antimicrobial resistance (AMR) is a natural process in bacteria, antibiotic use makes it worse. Bacteria can become resistant to antibiotics when they:
1.       turn on certain internal resistance processes
2.      change to protect themselves from an antibiotic
3.      receive resistant genes from other bacteria.
The main cause of antibiotic resistance is antibiotic use. When we use antibiotics, some bacteria die but resistant bacteria can survive and even multiply. The overuse of antibiotics makes resistant bacteria more common. 
The more we use antibiotics, the more chances bacteria have to become resistant to them. This means that antibiotics won’t work when we need them in the future. If we decrease antibiotic use, the antibiotics may again become effective at killing bacteria.
Even, Poor hygiene and poor infection prevention and control can:
1.       provide more opportunity for resistant bacteria and other germs to spread
2.      make more people sick and increase the need for antibiotics.
3.      Hand hygiene is the most important way of preventing the spread of infections including antibiotic resistant infections.
Antibiotic resistance is more common in some countries, and different countries can have different types of resistant bacteria. Travellers can become sick by:
1.       eating contaminated food
2.      drinking contaminated water
3.      touching contaminated surfaces
4.      contact with animals
5.      receiving medical treatment overseas.
They can then bring these resistant bacteria back to their home country.
However, there are some other factors which increase AMR and broadly those can be understood as follow-
1.    Agriculture use
Use of antibiotics in animal’s farm can lead to drug resistance. Scientists have found drug-resistant bacteria in meat and food crops that have exposure to fertilize contaminated water, in this way, diseases that affect animals can pass to humans.

2.    Hospital use
Critically ill people often get high doses of antimicrobials. This encourages the spread of AMR microbes, particularly in an environment where various diseases are present.

As infections stop responding to current drugs, there is an urgent need to find alternatives. In some cases, this means using combinations of different medications, known as multiple-drug therapy. Scientists are also looking for new forms of treatment, including different types of antibiotic and other alternatives.
Scientists have proposed some novel ways of combating bacteria. These include the following techniques, which researchers are investigating for the treatment of Clostridium diffiicile (C.difficile)
Using a virus consumes bacteria, known as a bacteriophage, in drug form.
Using monoclonal antibodies that can combat the effects of the toxins which microbes produces.
Why is AMR a global concern?
New resistance mechanisms are emerging and spreading globally, threatening our ability to treat common infectious diseases, resulting in prolonged illness, disability, and death.
Without effective antimicrobials for prevention and treatment of infections, medical procedures such as organ transplantation, cancer chemotherapy, diabetes management and major surgery (for example, caesarean sections or hip replacements) become very high risk.
Antimicrobial resistance increases the cost of health care with lengthier stays in hospitals and more intensive care required.
Antimicrobial resistance is putting the gains of the Millennium Development Goals at risk and endangers achievement of the Sustainable Development Goals.
Some Examples of AMR
There are cases of resistance like TB, Malaria etc where the cases of AMR made treatment severe.
Resistance in tuberculosis (TB)
According to WHO, in 2014 there were 480000 new cases of multi drug resistance TB. That meant, people who developed AMR were not treated by the anti – TB Drugs.
However, not every case of tuberculosis is reported. Due to unawareness, globally, only half of MDR-TB patients were successfully treated in 2014.
Among new TB cases in 2014, an estimated 3.3% were multidrug-resistant. The proportion is higher among people previously treated for TB, at 20%.
Extensively drug-resistant tuberculosis (XDR-TB), a form of tuberculosis that is resistant to at least 4 of the core anti-TB drugs, has been identified in 105 countries. An estimated 9.7% of people with MDR-TB have XDR-TB.
Resistance in malaria
As of July 2016, resistance to the first-line treatment for P. falciparum malaria (artemisinin-based combination therapies, also known as ACTs) has been confirmed in 5 countries of the Greater Mekong subregion (Cambodia, the Lao People’s Democratic Republic, Myanmar, Thailand and Viet Nam).
In most places, patients with artemisinin-resistant infections recover fully after treatment, provided that they are treated with an ACT containing an effective partner drug.
 However, along the Cambodia-Thailand border, P. falciparum has become resistant to almost all available antimalarial medicines, making treatment more challenging and requiring close monitoring.
There is a real risk that multidrug resistance will soon emerge in other parts of the subregion as well. The spread of resistant strains to other parts of the world could pose a major public health challenge and jeopardize important recent gains in malaria control.
WHO response against AMR
WHO is providing technical assistance to help countries develop their national action plans, and strengthen their health and surveillance systems so that they can prevent and manage antimicrobial resistance. It is collaborating with partners to strengthen the evidence base and develop new responses to this global threat.
WHO is working closely with the Food and Agriculture Organization of the United Nations (FAO) and the World Organisation for Animal Health (OIE) in a ‘One Health’ approach to promote best practices to avoid the emergence and spread of antibiotic resistance, including optimal use of antibiotics in both humans and animals.
A political declaration endorsed by Heads of State at the United Nations General Assembly in New York in September 2016 signaled the world’s commitment to taking a broad, coordinated approach to address the root causes of antimicrobial resistance across multiple sectors, especially human health, animal health and agriculture. WHO is supporting Member States to develop national action plans on antimicrobial resistance, based on the global action plan.
WHO has been leading multiple initiatives to address antimicrobial resistance:
1.       World Antibiotic Awareness Week
Held every November since 2015 with the theme “Antibiotics: Handle with care”, the global, multi-year campaign has increasing volume of activities during the week of the campaign.
2.      The Global Antimicrobial Resistance Surveillance System (GLASS)
The WHO-supported system supports a standardized approach to the collection, analysis and sharing of data related to antimicrobial resistance at a global level to inform decision-making, drive local, national and regional action.
3.      Global Antibiotic Research and Development Partnership (GARDP)
A joint initiative of WHO and Drugs for Neglected Diseases initiative (DNDi), GARDP encourages research and development through public-private partnerships. By 2023, the partnership aims to develop and deliver up to four new treatments, through improvement of existing antibiotics and acceleration of the entry of new antibiotic drugs.
4.      Interagency Coordination Group on Antimicrobial Resistance (IACG)
The United Nations Secretary-General has established IACG to improve coordination between international organizations and to ensure effective global action against this threat to health security. The IACG is co-chaired by the UN Deputy Secretary-General and the Director General of WHO and comprises high level representatives of relevant UN agencies, other international organizations, and individual experts across different sectors.

A way ahead
The world is already feeling the economic and health consequences as crucial medicines become ineffective. Without investment from countries in all income brackets, future generation will face the disastrous impacts of controlled antimicrobial resistance. Recognizing that human, animal, food and environmental health are closely interconnected, the report calls for coordinated, multi-sectoral “One Health” approach.
     Antimicrobial resistance is a complex problem that affects all of society and is driven by many interconnected factors. Single, isolated interventions have limited impact. Coordinated action is required to minimize the emergence and spread of antimicrobial resistance.
All countries need national action plans on AMR. Greater innovation and investment are required in research and development of new antimicrobial medicines, vaccines, and diagnostic tools.







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