The world recently observed the World Antimicrobial Awareness Week (WAAW) from November 18th to November 24th as antimicrobial resistance (AMR) continues to be a growing menace, tagged as a silent pandemic threatening global public health and modern medicine. Generally, Antimicrobials are agents that include antibiotics, antivirals, antifungals, and anti-parasitic and have been enormously vital to modern medicine.
In recent years, the impact of antimicrobial resistance has become too glaring with the emergence of new infectious agents, such as SARS-COV-2, the agent of COVID-19. In reflecting on this year’s theme ‘preventing antimicrobial resistance together’, we can better understand the impact of antimicrobial resistance and create awareness among the general public.
Historically, shortly after antibiotics were introduced into clinical use, antibiotic resistance emerged, and this threat to public health continued to grow faster, influenced by two main factors: resistance as a natural phenomenon and by actions and actions of man. In straightforward terms, Antimicrobial resistance is the ability of microorganisms to remain recalcitrant to drugs (antimicrobials) that they were previously susceptible to. This could result in difficulty in the treatment of simple infections.
As of 2019, infections related to antibiotic-resistant bugs have caused over 4 million deaths annually. AMR continues to be an issue of concern on all fronts, as its impact by 2050 is projected to generate over 10 million deaths annually with billions of dollars in economic loss if the ravaging threat is not curbed and will subsequently push the world to a post-antibiotic era, where mild infection will not be treated with all available antibiotic and routine medical procedure such as Caesarian section (CS) will not be possible.
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Drivers of resistance
Antimicrobial resistance is a natural phenomenon with complex, multifaceted, interwoven factors. However, chief blame goes to the indiscriminate use and misuse of antimicrobials for both therapeutic and non-therapeutic purposes, rendering these once-miraculous drugs ineffective. There is a rise in antibiotic use globally, but that of Sub-Saharan Africa and Nigeria in particular is spectacular.
Applications of antibiotics in animal husbandry and aquaculture are also significant drivers of resistance. Essentially, these drugs are deployed in agriculture, such as fish farming and poultry.
Regarding global antibiotic intake, there is evidence that more than 70 per cent of antibiotics are used in agriculture, especially livestock production. This is due to the quest for meat and meat products. This practice could lead to the accumulation of antibiotic residues in meat with a potential emergence of antibiotic resistance.
There is growing evidence of antibiotic residues in Nigeria, particularly in meat and milk from animal sources. In Nigeria, Antibiotic abuse and misuse have been widely accepted, and people get used to taking antibiotics without a prescription because antibiotics are readily available at the roadside with vendors due to lack of strict antibiotic stewardship.
The use of broad-spectrum antibiotics without laboratory results is another key contributing factor to the emergence and development of antibiotic resistance, which increases the natural selection of new resistant germs to thrive. This practice should be watched, and more robust antibiotic stewardship should be encouraged.
The emergence of resistant organisms occurred unprecedentedly, while pharmaceutical companies lost interest in investment in research and development of novel antimicrobials, and the antimicrobial pipeline continued to reduce.
Prevention
As the causes of the emergence and development of antimicrobial resistance are multifaceted, multiple efforts from individuals, communities, and governments are required to curb the spread of resistant organisms. Antimicrobial resistance as a natural phenomenon seems to be a complex issue to be put under check. However, there are possible middle answers to reduce the occurrence of resistant organisms.
One of the simple ways is public awareness campaigns to enlighten the general public on the dangers of AMR. In return, individuals can make informed decisions about antimicrobial use and promote preventive measures to reduce the burden of infections. Collective infection prevention and strategy at all levels could reduce the burden of infection where no antimicrobial is needed. This can be achieved through availability and access to clean water and hygiene. Another effective way to reduce the emergence of AMR is through vaccination, especially among the population at high risk, such as children, older people, high risk individuals.
Engagement of experts through a collaborative approach such as One Health Concept will go a long way to understanding the interplay between the health of humans, animals, and the environment. The government should enforce the regulation of antimicrobial use in human and animal health and strengthen surveillance systems to track AMR trends and inform effective policies.
As this year’s theme says, ‘preventing antimicrobial resistance together’, let’s make concerted efforts to curb AMR’s threat to the “magic bullet” and modern medicine.
Dr Adam Mustapha is a Clinical and Medical Microbiologist, Head, Department of Microbiology, Faculty of Life Sciences, University of Maiduguri.
