Inhibiting the development of antimicrobial resistance: a new effort
A scientific article by Togoobaatar et al., Published in the Bulletin of the World Health Organization in December 2010, reports that more than 40% of children in Mongolia take antibiotics to treat respiratory infections in the absence of a medical prescription. 1 In another article recently published by Kumarasamy et al., Attention is drawn to the serious threat posed by the super bacteria NDM-1 (metallo-β-lactamase-1 from New Delhi), surveillance of this microbe is limited and its effective treatment is limited. no. 2 Almost 10 years after the publication of the WHO Global Strategy for Antimicrobial Resistance, the World Health Organization has declared this issue to be the theme of World Health Day 2011. 3
Antimicrobial resistance is a serious problem that undermines efforts to control infectious diseases and could potentially halt or even reverse progress. The development of resistance is a natural response of microbes, but it can be suppressed by careful and appropriate use of antibiotics. Western European countries have been able to reduce the resistance of certain pathogens to antimicrobials by adopting an integrated approach within comprehensive and well-regulated health systems. 4 Comprehensive monitoring of antibiotic use and resistance, coordinated and government-funded education for people who prescribe and take antibiotics and regulate their use in communities and hospitals show that it is possible to restrict the antimicrobial resistance. Unfortunately, even in well-regulated systems, for example in Europe, the resistance of certain pathogenic microorganisms continues to increase and there are problems with the use of antibiotics outside the health system, especially for purposes veterinarians.
What about a developing world with much weaker regulation and scarce diagnostic tools, where comprehensive health care is a distant prospect? Fragmented health services, mainly in the private sector, which seeks to profit, make antibiotics an easy target for misuse and inappropriate use. 5 It is possible that under limited surveillance conditions, the true extent of antimicrobial resistance is unknown, and shooting stars such as NDM-1 draw attention to this problem.
There is enough scientific knowledge about the proper use of antibiotics. Specific antibiotics are only effective for certain microorganisms, they must be taken in certain doses and for a certain period of time, and they are ineffective against viral infections. What then leads to behavior contrary to this data?
There is a misconception that all infections respond to antibiotics. So it seems that many patients - patients with viral respiratory tract infection who feel better after taking amoxicillin, but this usually happens due to the natural course of the disease, not reason for taking amoxicillin (they may think that diarrhea as a side effect of the antibiotic is actually symptomatic of the disease). Mothers believe it is safer to give children antibiotics than to inhale steam and give paracetamol. Doctors prescribe antibiotics for simple viral infections to otherwise healthy patients to prevent possible secondary bacterial infections, despite the fact that reliable clinical trial data indicate the futility of such prevention. Pharmacists in developing countries are ready to dispense antibiotics without a prescription, as their income depends on sales and not on fees or salaries. Pharmaceutical companies can promote the sale of antibiotics whatever the needs of patients. And, finally, such misuse of the majority of antibiotics such as safety and the short duration of treatment lead to misuse; patients often decide to take antibiotics themselves, while fewer people take drugs that lower their blood pressure.
Combating this behavior with poor health infrastructure, limited regulation and inadequate health education is a completely new problem. Repeated calls for better regulation of medicines should not hinder proper access; the use of antibiotics in low- and middle-income countries will continue to grow to meet the needs in underserved areas. This widespread use should be associated with rational use. Better access to drugs without significant improvement in the proper use of antibiotics will have disastrous consequences, including the continued emergence of superbugs and untreatable infections. Fortunately, improving the proper use of antibiotics in most communities tends to reduce health care costs, as the use of antibiotics in many communities is, for the most part, unnecessary.
Retaining the development of antimicrobial resistance is the theme of World Health Day 2011. The World Health Organization is developing a comprehensive set of strategies so that ministries of health can work with almost all stakeholders. This should initiate sustainable actions to contain resilience, increase awareness and education through electronic media, as well as to monitor and control the spread of resilience through the use of improved computing and better support in clinical decision making by developing and using bedside diagnostics.
In any case, it would be wise to remember the mothers of Mongolia. Until there is a full set of measures to resolve their problems, a random supply of antibiotics will continue. Regulation, education and health care, taking into account socio-cultural and economic factors and using improved global information exchange, should be essential elements of new efforts to curb the development of antimicrobial resistance.