Covid-19 has brought antimicrobial resistance into spotlight. A systemic review found that while there were only 6.9% of 3338 covid-19 patients with bacterial infection, 72% of them had received antibiotics. The adverse impact of this irrational use of antibiotics in covid patients will manifest itself in future, warned Dr Getahun.
Agrees Dr Ishwar Gilada, Secretary General of OMAG (Organized Medicine Academic Guild) which brings several associations of medical experts on one forum in India: "The Covid-19 pandemic has provided another example of how irresponsibly and inappropriately antibiotics as well as antivirals were used. We need collective and urgent action to stop indiscriminate use of antimicrobials (be it antibiotics, antivirals or antifungals)."
Dr Getahun added: "Antimicrobial resistance is a complex problem that demands a comprehensive, multisectoral response. It is to be addressed through different mechanisms -including regulations and also by enhancing the robustness of the human and veterinary health systems to make sure that antimicrobials are prescribed based upon the needs and not due to oversight of the trained medical professionals. Antibiotics should not be sold over the counter."
Why we need food, veterinary, human health and environment sectors to join forces for combatting antimicrobial resistance?
"We need different sectors- food sector, veterinary sector, human health sector and environment sector- to work together and coordinate for the One Health approach. Humans are abusing antibiotics not only in the human health sector, but also in agriculture and livestock. The more we use antimicrobials in any sector, the greater are the chances that resistance will develop and the drugs will become ineffective. In humans, antibiotics are often used as substitutes for decent infrastructure, decent hygiene measures and for proper diagnosis and treatment. Over 30% of health facilities do not have running water supply- so it is difficult to practice good hygiene in such environments. So antibiotics are used as a cheaper substitute. There is widespread use of antibiotics for prevention of infection and in treating infections that will not respond to antibiotics- like flu, where antibiotics will not work (as it is a viral infection)" said Dr Elizabeth Tayler, Technical Lead for WHO in the Tripartite Joint Secretariat for AMR, supporting the collaboration between FAO, OIE, UNEP (UN Environment Programme) and WHO at global, regional and country levels. She has led the development of the Tripartite Strategy and the development of the AMR multi-partner Trust Fund.
In animals, there is a push to intensify livestock production, very often in unsanitary facilities with poor biosecurity. So antibiotics are used to prevent infections. Sub-therapeutic doses of antibiotics are used for growth promotion in livestock and also for blanket prevention in animal herds. In many countries more antibiotics are being fed to healthy animals than to sick humans and sick animals.
Dr Tayler underlined that antimicrobials are increasingly used in plant kingdom - 440,000 kg streptomycin and tetracycline sprayed on citrus tress (like orange trees) in California, drug resistant Aspergillus has been linked to use of the anti-fungal Azole (used to treat fungal infections in humans) in tulip industry. Anti-fungals are used in flower production that leads to resistance in humans.
Antimicrobials leak into the environment. Significant antibiotic residues have been found in effluents from intensive agriculture and from hospitals- all ending up in the river waters used by people to bathe and drink. In some cases levels of antimicrobials compounds in waters around medicine manufacturing sites have been found to be higher than therapeutic concentrations in the blood of patients taking those medicines.
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