Antibiotics/antimicrobial resistance a looming public health catastrophe
On Monday, 16 November, South Africa joins the international community in responding to the World Health Organisation’s (WHO) call to raise awareness during World Antibiotic Awareness Week of the need to preserve the power of antibiotics through appropriate and rational use.
Without effective antibiotics, a growing list of infections is becoming harder to treat. These include pneumonia, urinary tract infections, tuberculosis and gonorrhoea (or STD’s). Without urgent action, the world is headed for a ‘post-antibiotic era’ in which common infections and minor injuries which have been treatable for decades can once again kill patients, and the benefit of advanced medical treatment such as chemotherapy and major surgery will be lost.
“In South Africa, we are burdened with a triple threat of antibiotic resistance in the form of drug resistant Tuberculosis, HIV and antibiotic resistant Bacteria. It is one of our greatest threats to preserving the significant health gains we have made in treating and preventing these diseases in the last 5 years”, says Minister of Health, Dr Aaron Motsoaledi. “ We are calling on all citizens and health care professionals to take serious the call to reduce our use of antibiotics before we allow serious infections to become untreatable and lose millions of lives from antibiotic resistance.”
The Lancet Series on Effective Antimicrobials: access and sustained effectiveness, November 2015, which will be launched on 18th November, estimates that 214 000 neonatal deaths occur due to serious infections caused by antibiotic resistant organisms.
The Report emphasises the importance of securing access to antibiotics, in a sustainable and equitable manner crucial to achieve health outcomes. Low and Middle Income Countries (LMICs) such as South Africa often experience challenges is providing access to life saving antibiotics in the most rural underserviced areas. Improving access to these underserviced rural areas could avert 445 000 community acquired pneumonia deaths in children younger than 5 years across the world the report estimates.
In South Africa, the impact of prevention of infection through childhood vaccines has been demonstrated recently; in particular the prevention afforded by the pneumococcal conjugate and rotovirus vaccines. Overall child mortality rates have declined substantially in the past 5 years from diseases related to these two vaccines specifically diarrhoea with dehydration and pneumonia as well as hospitalisation and deaths from these two illnesses (Ref: SAMJ, March 2014, Vol 104, no. 3 suppl “Effectiveness of pneumococcal conjugate vaccine and rotavirus vaccine introduction into the South African public immunisation programme).
However this increasing access comes with the paradoxical threat of increasing organism resistance due to inappropriate use. So we have a unique global health dilemma; how do we increase access where it is needed and preserve the effectiveness of these antibiotics by restricting their use to appropriate illnesses and health care settings.
In the recent State of the World’s Antibiotics reports published by the Centre for Disease Dynamics, Economics and Policy in September 2015, shows that consumption of antibiotics in South Africa is growing dramatically, driven by prophylaxis for HIV patients using cotrimoxazole but also by the use of broad spectrum penicillin’s in the community and General Practitioner setting. This consumption represents signals there may be significant inappropriate use occurring in the community.
The increased consumption of antibiotics is resulting in an increase in antibiotic resistance. In more than a quarter of cases, South Africa is seeing resistance to some of the most dangerous infectious organisms to commonly used antibiotics. Organisms that cause urinary tract infections in the community setting and skin infections are showing a 30% resistance to the common antibiotics used to treat them.
A survey recently conducted by the WHO (Antibiotic Resistance: multi country survey, November 2015, WHO) and released during World Antibiotic Awareness Week, reveals that there is widespread public misunderstanding about antibiotic resistance.
Antibiotic resistance occurs when bacteria change in response to the use of antibiotics. While this happens naturally, this is accelerated by the over-use and misuse of antibiotics, leading to record high levels of antibiotic resistance. In South Africa, the survey found that two thirds of citizens thought that antibiotics are useful for common cold and flu which do not respond to antibiotics as they are caused by viruses.
It is not too late to reduce the impact of antibiotic resistance and the NDOH wants to highlight that all citizens have a part to play in preserving the effectiveness of antibiotics. “By reducing the spread of infections and changing how we produce, prescribe and use these medicines, we can reduce the impact and limit the spread of antibiotic resistance. Therefore it is vital that every citizen and health care professional thinks carefully about using or prescribing antibiotics”, says the Minister.
Enquiries:
Popo Maja
Tel: 012 395 9591
Cell: 072 585 3219
E-mail: MajaP@health.gov.za /Popom@polka.o.za
