Antimicrobial Resistance: Where Did We Go Wrong In Our Efforts To Help Humanity?

 

By Nana Afua Agyemang Mensah-Bonsu

Antibiotics were discovered in a stroke of luck almost a century ago like an answered prayer to the cries of mankind as lives were being lost to and heavily affected by (treatable) infections.

Unbeknownst to man, the discovery of antibiotics brought in its wake, poor antibiotic usage and practices which has led to Antimicrobial Resistance, a public health and healthcare menace taking us back to square one.

The first true antibiotic known to man is Penicillin. This was discovered in 1928 by Alexander Fleming, a Scottish bacteriologist who returned from a vacation to find green mold (Penicillium notatum) growing in one of his petri dishes which contained Staphylococcus, bacteria known to cause boils and sore throats, inhibiting the growth of the bacteria.

Upon further research, he found out that the mold produced a substance that was capable of killing common bacteria that infect humans.

It took more experiments before Penicillin was ready to be used in humans in 1941. One of the first patients to be treated with injection of penicillin, Constable Albert Alexander, initially benefitted from it however only a small amount had been extracted leading to a relapse of the infection by the fifth day and his eventual death. After more efforts by other researchers to enhance mass production of penicillin, their hard work was rewarded later that year at a time where many soldiers were being wounded in World War II.

A few years later, in 1945, Fleming while giving a speech, cautioned on the dangers of misusing penicillin. By 1947, reports went out on the first case of penicillin resistance. About half of the antibiotics we know of were discovered between 1950 and 1960, hence this period is referred to as “The golden age of Antibiotic discovery'.

Healthcare today has become heavily dependent on antibiotics. Majority of the masses only link antibiotic usage with treatment of infections such as urinary tract infections, pneumonia and ear infections to name a few. However, its use in healthcare goes deeper than that. Antibiotics play a role in most surgical interventions, organ transplant, chemotherapy and even in the care of premature babies since their immunity is low making it harder for their bodies to fight infections.

Antimicrobial resistance comes about when/ is caused by using the 'wrong' antibiotic to treat an infection, using a lower dose than needed to eradicate the causative organism and taking the antibiotic for a shorter duration than what is recommended to properly treat the infection resulting in reduced effectiveness of antibiotics.

Our frequent and over-enthusiastic usage of antibiotics at the least sign of an infection, without taking the necessary precautions and investigations has contributed to the establishment of microorganisms that are resistant to not only one antibiotic, but multiple ones at the same time. This is known as multidrug resistant bacteria.

Every individual is now at risk of contracting drug resistant infections which require a more aggressive therapy of combining different agents as well as using reserved antibiotics. As such, the world is slowly entering the post-antibiotic era where most bacteria will be resistant to the currently available and existing antibiotics.

Antimicrobial resistance has been declared by the WHO as one of the top 10 global public health threats facing humanity. The main drivers of the development and spread of drug resistant pathogens are misuse and overuse of antimicrobials coupled with lack of clean water and sanitation and inadequate infection prevention and control. The lack of awareness and knowledge, lack of enforcement of legislation, poor access to quality, affordable medications, vaccines and diagnostics also play a role.

Another cause that may be overlooked by the general populace is the extensive use of antimicrobials in agriculture, especially as growth supplements in livestock with the end goal of promoting growth and preventing infection. This improves the overall health of the livestock, resulting in larger yields and products of higher quality. Antibiotic usage in food producing animals either suppresses or kills the susceptible bacteria, allowing bacteria resistant to antibiotics to thrive which can cause infections in humans when transmitted via consumption of the meat.

Some measures that have been put in place by the WHO to combat AMR are:

WAAW- formerly known as World Antibiotic Awareness Week. Since 2020, it's been changed to World Antimicrobial Awareness Week to include antifungals, antivirals and anti-parasitics. WAAW is a global campaign that has been held annually from 2015 aiming at raising worldwide awareness on AMR and also encouraging the best practices among health workers, policy makers and the general public in a bid to slow the development and spread of drug resistant infections.

The Global Antimicrobial Resistance and Use Surveillance System- GLASS, which was launched in 2015 with a main purpose filling gaps in our AMR knowledge and to inform strategies. GLASS incorporates data from AMR surveillance in humans, surveillance of antimicrobial medication usage, AMR in the food chain and the environment.

Practices that can be implemented in the health care settings include avoiding prescribing antibiotics when there is no clinical evidence of bacterial infection or for self-limiting conditions; taking samples for microscopy, culture and sensitivity before prescribing or initiating antimicrobial therapy and reviewing the prescriptions when the test results are ready; and adhering to local guidelines for antimicrobial usage.

*Dr. Nana Afua Agyemang Mensah-Bonsu is a Ghanaian