Pakistanis’ resistance to antibiotics is a fatal problem

Pakistanis’ resistance to antibiotics is a fatal problem

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Antimicrobial drug resistance (AMR) or antibiotic resistance is a major global public health issue, and according to World Health Organization estimates, it causes 700,000 deaths per year. This figure is expected to rise to 10 million deaths in the next 35 years, mostly in developing and low-income countries, with Pakistan ranking among countries with the highest rate of drug resistance in the world, alongside Afghanistan, Kenya and Uganda.
The importance of antibiotics in combating and treating infections cannot be over-emphasized. In 1928, when Alexander Fleming discovered Penicillin, which heralded the dawn of the antibiotic era, it was recognized as one of the major milestones in therapeutic medicine and changed the course of medical history. 
However, an overuse of antibiotics, prevailing poor hygiene and infection control in developing countries (poor quality drinking water and an inadequate sewage system), as well as a paucity of new drugs, are leading to the rise of AMR. In most cases, antibiotics are not properly prescribed, either when they are not needed, or given in the incorrect dose or duration. As a result, treatments become ineffective, resulting in the persistence of an infection. This has resulted in an increase in the burden of infections due to organisms that are resistant to antibiotics. In Pakistan, we are facing the dilemma of dealing with Extensively Drug Resistant (XDR) typhoid, tuberculosis as well as certain strains of malaria. 

Strategies and interventions focusing on the prudent use of anti-microbials and limiting their random and irrational use in all health care settings have to be implemented as an immediate priority.

Dr. Mehreen Mujtaba


Also, self-medication with antibiotics is highly prevalent. There is a general lack of knowledge on the part of patients regarding the misuse of antibiotics, and these medicines are used to treat simple ailments like the common cold and flu. 
It is however, worthy to note that the onus of this burden cannot be ascribed to end-use consumers only, but can be attributed in fact, to all factors at various levels of the health system, including a lack of policy enforcement and regulation, negligence on the part of the health care providers as well as consumer health care seeking behaviors. Over the counter sales of antibiotics is a major contributing factor. 
Medical practitioners have also been known to prescribe antibiotics when not required due to the monetary kickbacks offered by pharmaceutical companies. Until a few years ago, there was no nationwide surveillance to capture data or any action plan to address the growing threat of AMR. 
In 2015, the World Health Assembly passed a resolution to tackle the growing issue of AMR through a “One Health Approach.” According to this resolution, member states were urged to develop their own action plans to combat the threat of AMR both in humans as well as animals. The aim of such an action plan was to ensure successful treatment and prevention of infections with effective, safe, quality assured medicines used in a responsible way. 
It is encouraging to know that following the commitment to the WHA Resolution, in 2017, the government of Pakistan embarked upon a National Action Plan (NAP) for addressing the menace of AMR. The main objectives of this NAP are to raise awareness regarding antimicrobial resistance, improve prevention and control infections.
Strong regulations on the part of the government both at the national as well as provincial levels, a code of conduct for prescribing and usage of antibiotics as well as responsible marketing, can help curtail the problem to a large extent. 
Strategies and interventions focusing on the prudent use of anti-microbials and limiting their random and irrational use in all health care settings have to be implemented as an immediate priority. These steps are expected to have a major impact on reducing infection rates, resistance patterns, costs and improving clinical outcomes. Alongside these policies, this menace can be controlled by improving civic facilities, with the provision of clean drinking water and infection control at the grass roots level.

-Dr. Mehreen Mujtaba is a freelance consultant working in the areas of environment and health.

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