Containing antimicrobial resistance
Comprehensive policy package for healthcare
Antibiotic or antimicrobial resistance is a serious problem that strikes at the core of infectious disease control and has the potential to halt, and possibly even to roll back, progress. While it is a natural response of microbes, resistance can be contained through careful and appropriate antibiotic use. Western European countries have managed to decrease the rate of antimicrobial resistance in some pathogens through a multipronged approach in comprehensive well regulated health systems. Integrated monitoring of antibiotic consumption and resistance, prescriber and consumer education that is coordinated and paid for by the government, and regulation of use in communities and hospitals have shown that it is possible to contain antimicrobial resistance. Unfortunately, even in well regulated systems, resistance in some pathogens continues to increase unabated and problems remain. What about the developing countries like Bangladesh — where there is much less monitoring, diagnostics are sparse and comprehensive healthcare is a distant prospect? Fragmented health services, mainly in the profit-driven private sector, make antibiotics an easy target for misuse and abuse. There is sufficient scientific knowledge about appropriate antibiotic use. Specific antibiotics are effective only against certain organisms, must be taken in a particular dose for a specified duration, and they are ineffective against viral infections. There is the fallacy that all infections respond to antibiotics. Many patients with a viral respiratory tract infection feel better after taking antibiotic Amoxicillin. This is usually due to the natural course of the illness and not to the Amoxicillin (they may think that the antibiotic's side-effect of diarrhoea is actually a symptom of the illness). Mothers feel safer giving children antibiotics rather than steam inhalations and Paracetamol. Physicians prescribe antibiotics for simple viral infections in otherwise healthy patients to prevent possible secondary bacterial infections, despite good clinical trials showing no value of such prophylaxis. Quakes readily dispense antibiotics without prescription as their income depends on sales rather than on a professional fee or salary. Pharmaceutical companies may promote sales of antibiotics independent of patient need. Finally, most antibiotics, by virtue of their safety and short courses, lend themselves to abuse; patients often take antibiotics of their own accord, whereas few people would take antihypertensive medications on their own. Combating these behaviours in the settings with poor healthcare system, limited regulation and inadequate health education is a big challenge. Repeated calls for better regulation of medicine must not obstruct appropriate access; antibiotic use will continue to grow in low- and middle-income countries to meet under-served needs. Such increased use must be tied to rational use. Improved drug access without significant improvements in appropriate use will have dire consequences, with continued emergence of "superbugs" and untreatable infections. Improvements in the appropriate use of antibiotics generally reduce health costs as the majority of antibiotic use in most communities is unnecessary. Containing antimicrobial resistance is the theme of World Health Day 2011. The World Health Organisation is developing a comprehensive policy package for health ministries addressing nearly all stakeholders. This should be an opportunity to launch sustainable action to contain resistance, raise awareness and educate target people using electronic media. Alongside it will help to track and contain spread of resistance with improved informatics and better clinical decision support bedsides diagnostics.
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