Thursday, April 7, 2011

World Health Day April 7, 2011: The WHO Call to Combat Drug Resistance

World Health Day 2011 web button

One of my set speeches in Medicine includes the following elements, tailored to the individual patient/ friend/ family member: "You have a virus, you don't need an antibiotic; an antibiotic won't help with a virus; it will increase your resistance to antibiotics when you do need them, and contribute to the creation of drug resistant strains". This speech obtains cross-culturally and internationally, despite national differences in prescribing practices,  expat beliefs that only doctors in their own countries know how to properly prescribe antibiotics, and near universal belief that one's own medical misery requires an antibiotic no matter the standard practice.

There are times when an antibiotic may be given even for a viral infection, most often in someone with immune-comprise, or fragility, to prevent a supra-infection with a bacterium, or when such a microbial infection on top of the virus is suspected of being already be present.

Generally, one might argue that almost all prescriptions of antibiotics are overprescriptions, because generally recommended numbers of days on the antibiotic have been increased by medical experience with most patients not taking the full prescription. In that way, when they do stop early because their symptoms have been relieved, and they want to save a few pills "just in case" they get the same infection again, they have probably had a decent course of treatment.

However, this stop-start pattern, where patients stop a prescription early, contributes to relapse (the same infection becomes symptomatic again) or to early recurrence (they are susceptible to re-infection by the same microbe soon after treatment). It also contributes to creating drug resistant strains of infective agents. The same is true of the unofficial but real practice in some places of prescribing a short course of antibiotics so that the patient has to return and pay another physician's visit to extend the prescription.

Fortunately, I rarely need an antibiotic, but when I do, I finish the prescription--unless the side effects are so bad that I decide to revisit the physician for a new one. Recently, I did need a prescription urgently, went to the nearest walk-in clinic, and got a 7 day prescription for a broad spectrum antibiotic--one that would cover most common infective organisms. On day 6 there was so little improvement, that I planned day 7 to include a return visit, and a request for a "culture and sensitivity" of the infection site, so that a prescription could be scientifically based on the specific organism, resistance, and specifically recommended antibiotic. Miraculously, I rose on the seventh day, cured! It was a good plan though, as was the initial prescription, a standard practice based on evidence that most often this approach is effective. I guess I should have had more faith in the baby-faced new family practice graduate!

As regards my own medical practise, now I know where my set speech on antibiotics fits in the broader scheme of creating drug resistance--combatting irrational drug use:


The WHO has special sites--in multiple languages (Arabic, English, French, etc)-- for World Health Day, with a great deal of useful information, including links to WHO region specific sites on the topic. Some of that information follows.


1)What is antimicrobial resistance?
Antimicrobial resistance or drug resistance is the ability of a microorganism (like bacteria, viruses and some parasites) to stop an antimicrobial (such as antibiotics, antivirals and antimalarials) from working against it. As a result, standard treatments become ineffective, infections persist and may spread to others.

2)Drug resistance is a global problem.
Over the past years, the use and misuse of antimicrobials has increased the number and types of resistant organisms. Consequently many infectious diseases may one day become uncontrollable. With the growth of global trade and travel, resistant microorganisms can spread promptly to any part of the world.

3)What causes drug resistance?
Drug resistance is a natural evolutionary phenomenon. When microorganisms are exposed to an antimicrobial, the more susceptible organisms succumb, leaving behind those resistant to the antimicrobial. They can then pass on their resistance to their offspring.

4)Inappropriate use of medicines leads to drug resistance.
Inappropriate use of antimicrobials drives the development of drug resistance. Both overuse, underuse and misuse of medicines contribute to the problem. Ensuring that patients are informed about the need to take the right dosage of the right antimicrobial requires action from prescribers, pharmacists and dispensers, pharmaceutical industry, the public and patients, as well as the policy makers.

5)Lack of quality medicines leads to drug resistance.
Most drug quality assurance systems are weak. This can lead to poor quality medicines, exposing patients to sub-optimal concentrations of antimicrobials, thus creating the conditions for drug resistance to develop. In some countries poor access to antimicrobials forces patients to take incomplete courses of treatment or to seek alternatives that could include substandard medicines.

6)Animal husbandry is a source of drug resistance.
Sub-therapeutic doses of antibiotics are used in animal-rearing for promoting growth or preventing diseases. This can result in resistant microorganisms, which can spread to humans.

7)Poor infection prevention and control amplifies drug resistance.
Poor infection prevention and control can increase the spread of drug-resistant infections. Hospitalized patients are one of the main reservoirs of resistant microorganisms. Patients who are carriers of resistant microorganisms can act as a source of infection for others.

8)Weak surveillance systems contribute to drug resistance.
Currently there are few well-established networks that regularly collect and report relevant data on drug resistance. Some countries lack laboratory facilities that can accurately identify resistant microorganisms. This impairs the ability to detect emergence of resistant microorganisms and take prompt actions.

9)The pipeline for new tools to combat drug resistance is drying up.
Existing antimicrobials are losing their effect. At the same time there is a decline in the development of new antimicrobials. Similarly, there is insufficient new research into new diagnostics to detect resistant microorganisms; and vaccines for preventing and controlling infections. If this trend continues, the arsenals of tools to combat resistant microorganism will soon be depleted.

10)WHO calls on stakeholders to combat drug resistance.
The threat from drug resistance is increasing. There is a need for urgent action; everyone can play a part. The complex problem of drug resistance requires collective action. On World Health Day, WHO is issuing a call for action to halt the spread of drug resistance by introducing a six-point policy package for all countries.

COMBAT ANTIMICROBIAL RESISTANCE

What is ANTIMICROBIAL RESISTANCE?

Antimicrobial resistance (AMR) is resistance of a microorganism to an antimicrobial medicine to which it was
previously sensitive. Resistant organisms (they include bacteria, viruses and some parasites) are able to withstand attack by antimicrobial medicines, such as antibiotics, antivirals, and antimalarials, so that standard treatments become ineffective and infections persist and may spread to others. AMR is a consequence of the use, particularly the misuse, of antimicrobial medicines and develops when a microorganism mutates or acquires a resistance gene.

Why is AMR a global concern?

>> AMR kills — Infections caused by resistant microorganisms often fail to respond to the standard treatment, resulting in prolonged illness and greater risk of death.

>> AMR challenges control of infectious diseases — AMR reduces the effectiveness of treatment because patients remain infectious for longer, thus potentially spreading resistant microorganisms to others.

>> AMR threatens a return to the pre-antibiotic era — Many infectious diseases risk becoming uncontrollable and could derail the progress made towards reaching the targets of the health-related United Nations Millennium Development Goals set for 2015.

>> AMR increases the costs of health care — When infections become resistant to first-line medicines, more expensive therapies must be used. The longer duration of illness and treatment, often in hospitals, increases health-care costs and the financial burden to families and societies.

>> AMR jeopardizes health-care gains to society — The achievements of modern medicine are put at risk by AMR. Without effective antimicrobials for care and prevention of infections, the success of treatments such as organ transplantation, cancer chemotherapy and major surgery would be compromised.

>> AMR compromises health security, and damages trade and economies — The growth of global trade and travel allows resistant microorganisms to be spread rapidly to distant countries and continents.

Facts on antimicrobial resistance

1) About 440 000 new cases of multidrug-resistant tuberculosis (MDR-TB) emerge annually, causing at least 150 000 deaths. Extensively drug-resistant tuberculosis (XDR-TB) has been reported in 64 countries to date.

2) Resistance to earlier generation antimalarial medicines such as chloroquine and sulfadoxine-pyrimethamine is widespread in most malaria-endemic countries. Falciparum malaria parasites resistant to artemisinins are emerging in South-East Asia; infections show delayed clearance after the start of treatment (indicating resistance).

3) A high percentage of hospital-acquired infections are caused by highly resistant bacteria such as methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci.

4) Resistance is an emerging concern for treatment of HIV infection, following the rapid expansion in access to antiretroviral medicines in recent years; national surveys are underway to detect and monitor resistance.

5) Ciprofloxacin is the only antibiotic currently recommended by WHO for the management of bloody diarrhoea due to Shigella organisms, now that widespread resistance has developed to other previously effective antibiotics. But rapidly increasing prevalence of resistance to ciprofloxacin is reducing the options for safe and efficacious treatment of shigellosis, particularly for children. New antibiotics suitable for oral use are badly needed.

6) AMR has become a serious problem for treatment of gonorrhoea (caused by Neisseria gonorrhoeae), involving even “last-line” oral cephalosporins, and is increasing in prevalence worldwide. Untreatable gonococcal infections would result in increased rates of illness and death, thus reversing the gains made in the control of this sexually transmitted infection.

7) New resistance mechanisms, such as the beta-lactamase NDM-1, have emerged among several gram-negative bacilli. This can render powerful antibiotics, which are often the last defence against multi-resistant strains of bacteria, ineffective.

يوم الصحة العالمي

Saudi Arabia's Statement in Honour of World Health Day

The International Islamic Relief Organization (IIROSA) has implemented 285 health projects in 48 countries since its inception. (AN photo)

IIROSA’s global outreach programs benefit 34 million patients
By ARAB NEWS
Published: Apr 6, 2011 23:19 Updated: Apr 6, 2011 23:19

JEDDAH: The International Islamic Relief Organization-Saudi Arabia has since its inception administered, operated and supported 285 health programs and projects, which benefited more than 34 million patients in 48 countries around the world.

Speaking on the occasion of the World Health Day on Thursday, IIROSA Secretary-General Adnan Khalil Basha said the Saudi relief organization's current fixed health projects number 32, comprising hospitals, health centers, dispensaries, clinics and pharmacies while there are 24 temporary projects and programs consisting of medical caravans, mobile clinics, surgical camps, awareness and environmental health programs benefiting more than 24 million patients.

The World Health Day is this year being celebrated under the slogan: “Antimicrobial Resistance: No Action Today, No Cure Tomorrow.”

Basha said the health projects implemented by IIROSA covered countries in Asia, Africa, Europe and South America. “The organization coordinated with a number of international organizations, such as the World Health Organization, to carry out health programs in favor of the poor and needy patients without any distinction as to gender, color or creed,” he added.

Enumerating the types of health services being provided by IIROSA, Basha said they consisted of treating the poor and needy free of charge; child and mother care; maternity care and children's vaccinations to children; free distribution of medicines; various medical checkups and screenings; and emergency care.

Basha pointed out that IIROSA has conducted heart surgeries and catheter operations for poor and needy children in a number of Arab and Islamic countries, including Yemen, Egypt, Syria, Morocco, Pakistan and Kazakhstan, with the help of volunteering Saudi specialists and consultants.

“More than 400 children who are unable to bear the high costs of such operations have benefited from IIROSA's services in this field. The organization has also examined more than 783 sick children,” he added.

The secretary-general pointed out that within its efforts to fight blindness, the IIROSA organized four campaigns for optical surgeries and eyesight corrections in a number of countries, including Indonesia, Sri Lanka, Nigeria and Burkina Faso.

On the domestic level, the organization extended relief assistance to the victims of flash floods and torrential rains in Jeddah in November 2009. It set up medical clinics in a number of hard-hit areas with the help of volunteering Saudi doctors. It extended medical equipment and medicines to a number of hospitals in Jeddah, including the General Eye Hospital, King Saud Hospital and the TB Center. It also provided the Health Welfare Society in Makkah with 32,000 kg of various medicines.

According to Basha, IIROSA contributed more than SR5 million to partly cover the costs of heart, kidney, liver and eye operations to 1,378 patients in various regions of the Kingdom. “Through agreements with a number of hospitals and pharmacies, the organization provides treatment and medicines to a number of poor and needy patients, especially the disabled,” Basha said.

He announced that IIROSA will implement a program to combat blindness in three regions in the Kingdom during which it will conduct 1,500 eye operations. He said it will also organize medical campaigns in other regions to cure more than 9,000 patients.

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Your comments, thoughts, impressions, experiences?

Related Posts:
World Health Day April 7-10 (April 1-May 9), 2010 Saudi Arabia
Stop TB Campaign Saudi Arabia

 Brochures on World Health Day 2011 for the WHO Eastern Mediterranean Regional Organization (WHO-EMRO), responsible for MENA countries in Arabic, English, and French.

3 comments:

oby said...

what a timely post...I have spent the last 11 days fighting some awful infection of some sort. have tried a z pac and nothing has worked. It has moved from my head to my chest leaking like crazy from the eyes and nose. Hanging in there but I have to admit a couple of times I was thinking that death might be preferable. LOL! I hope that I have tuned a corner this evening because my general level of misery seems to have lessened though that is not saying much. I am praying that it will be better tomorrow...taking it in hourly increments almost.

oby said...

also in USA they don't tend to culture anything... just give meds and cross fingers. I often think they give them because it is what the patient demands. I am glad that you advise against meds if not needed...my husband says the exact same thing...if it's viral hold on for the ride cause antibiotics are useless.

I am casting a very suspicious eye toward my daughter however...she was sick over spring break. My dad had an instant cardiac death incident (but survived absolutely fine)and we went down to see him...she was sick coughing all over me for the whole time we were there but I was fine...24 hours after arriving home I started with a fever and the same symptoms she had....and suspiciously even though she has kissed me goodnight etc...she seems to be resistant to this killer bug that I have gotten. Hmmmm...could it be she has immunity? AND does it amplify itself in intensity with each passing year? She seemed to be inconvenienced...I feel like hammered poop.

Wendy said...

I have to be near death or in desperate pain before I take drugs of any sort. In the past 10 years I think I've taken an antibiotic once. I do not run to the doctor for every little thing either so perhaps the two go hand in hand. Way too often patients demand the doctor 'fix' them and way too often the doctor complies with some drug or other. A close relative has been learning the hard way that by demanding her doctor 'fix' her problems and get her well without knowing the root of the problem has caused her more problems than she had in the beginning. I could explode when I hear that one or the other of my grandchildren are taking antibiotics and I often talk to my son about it but that's about all I can do. If I could afford to eat only products not treated with drugs I'd surely do it. Not always easy to find untreated meats, poultry and eggs either.

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