Dr. Shyam P Lohani

Antibiotics were considered a miracle cure against diseases, a wonderful weapon for prolonging life and treating infections. Antimicrobials that include antibacterials, antivirals, antifungals, and antiparasitics are drugs used for the prevention and treatment of infections in humans, animals, and plants. Microorganisms that develop antimicrobial resistance are sometimes also referred to as “superbugs”.

Over the years, the use and misuse of antimicrobials in humans, animals, and plants, poor prescribing and dispensing practices and lack of patient compliance, global trade, and increased intra-country movements, have accelerated the development and resulted in threats of antimicrobial resistance (AMR) worldwide. Antibiotic resistance is one of the biggest public health challenges for mankind. Unless the current pace of development of antibiotic resistance is not stalled, more antibiotics become less effective to inhibit or kill microbes causing infections. How dreadful it will be when antibiotics, which once were considered a miracle drug, are unable to treat infections.

Impact
Owing to the rapid development of AMR, an increased number of infectious diseases have become tough to manage, with dramatic health, economic, and developmental impacts. The development of antibiotics goes back to World War II when penicillin, the first antibiotic, was used to save millions of people's lives during and after that war. It is painful to admit that the number of newly approved drugs is declining, with only three new antibiotics receiving approval in the last 30 years. Moreover, the existing antibiotic is becoming less effective and/or failing to suppress or kill the pathogenic microorganisms.

The consequences of AMR on health and overall healthcare systems are phenomenal. Every year about 700,000 deaths occur due to multidrug-resistant infections. Unless urgent action is taken, it is estimated that the burden of deaths from AMR could reach 10 million each year globally by 2050. The staggering figure of mortality is feared to be more than the deaths due to all forms of cancer. In simple terms, AMR arises when bacteria, viruses, fungi, and parasites change over time and no longer respond to medicines, thus transforming infections harder to treat and increasing the risk of disease spread, severe illness, longer hospital stay, and death. The consequence of AMR is grave as the medicines become less effective and/or ineffective and infections persist in the body for a longer period of time, increasing the risk of spread to others.

The development and use of antibiotics has transformed our lives forever. Diseases that in the past could cause death (such as pneumonia) nowadays can be cured through antibiotic therapy. However, the World Health Organisation (WHO) has termed the growing AMR as “a slow tsunami that threatens to wipe out a century of medical progress” (WHO, 2021).
AMR presents a global public health menace. It is often a dynamic phenomenon that happens when bacteria, viruses, fungi, and parasites resist the effects of medications, making common infections tougher to treat, increasing the risk of disease spread, severe illness, longer hospital stay, and death. Antibiotic resistance is escalating to dangerously high levels throughout the world with the occurrence of new resistance mechanisms and spreading rapidly to a global level. With antibiotics becoming less effective, it has grown increasingly difficult, and oftentimes impossible, to treat patients for even common infectious diseases like pneumonia.

AMR not only threatens animal and human lives but also makes patient care more expensive as first-line antibiotics are being replaced by more expensive medications. Increased duration of illness and complicated treatment in hospitals increases healthcare costs as well as the economic burden on patients, societies, and the nation. In many developing countries, excessive use is due to the easy availability of antimicrobial drugs without the prescription of a qualified health professional. In a contrast situation, although antibiotics can be purchased without a prescription, owing to financial hardship, people in those countries use fewer doses of antibiotics for a shorter period of time than is actually needed.

The abuse and misuse of antibiotics and other antimicrobial drugs favour the development and spread of resistant microorganisms, and generates the need for alternative treatments that are effective against such pathogens. As a fewer new antibiotics are in the development pipeline, the need for more effective antibiotics is greater than ever. Moreover, new antibiotics developed have only limited effectiveness against resistant strains. Therefore, it is critical time for all of us to contain AMR so that antibiotics remain a powerful treatment option against infections, today and in the future.

Guidelines
In Nepal, AMR is growing at a rapid pace as evidenced by studies conducted in a limited number of hospitals. Moreover, the issue of AMR is neglected due to several other public health priority issues and improper implementation of existing programmes and policies. The use of antimicrobials in food animals, poultry, bees and fisheries, and also in agriculture has raised concern over the rapid development of AMR. The use of antimicrobials in other sectors than human is even less regulated and has the potential to contribute to the development of AMR in long run. The sub-therapeutic dose of antibiotics as a growth promoter in animal husbandry needs to be strictly controlled.

The Ministry of Health and Population published National Antibiotics Treatment Guidelines in 2014 with the aim of containing AMR. Alliance for the Prudent Use of Antibiotics (APUA) Nepal has developed national antibiotics policy which was later endorsed by the Government of Nepal. However, the implementation of both the policies and guidelines is not satisfactory.

Nepal along with the world has recently celebrated World Antimicrobial Awareness Week (WAAW) from 18-24 November 20121 with the aim to increase awareness of global antimicrobial resistance (AMR). The week calls for encouraging best practices among the population, health workers, and policymakers in order to overcome the further emergence and spread of drug-resistant infections. Lastly, it is called upon all stakeholders from prescribers, dispensers to consumers to work together to contain the spread of AMR and preserve the life-saving value of antibiotics.

(Prof. Lohani is the founder and academic director at Nobel College. lohanis@gmail.com)