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Tuesday, 5 January 2016

AntiMicrobial Resistance: an emerging public health emergency

AntiMicrobial Resistance (AMR) occurs when a microbe (Bacteria and other pathogens) mutates and make the drug targeted to it ineffective. Antibiotics discovered in the ‘50s revolutionized modern medicine and saved the lives of millions across the world, including animals. Without antibiotics, wonders of modern medicine such as major surgery, organ transplantation, and cancer chemotherapy would not have been possible. However, indiscriminate and unregulated use of antibiotics especially in the LMICs has given rise to the current serious public health problem.  This emerging epidemic is causing 700,000 lives worldwide, estimated to reach 10 million by 2050 if the current scenario continues. Besides, antibiotic use in the production of livestock, and therefore, contribution to the development of resistance and hemce, the concept of ‘one health’ (the concept that human health and well-being related to animal health and environment) is another dimension of the problem. However, the dilemma is: in this world, more people die due to lack of access to antibiotics than excess of antibiotics! Balancing the ‘access’ and ‘excess’ antibiotic poses a new challenge to the public health community in the world!

In recent times, use of antibiotic increased substantially due to improved economic condition and expansion of health services across the globe; during 2000 – ’10, antibiotic consumption increased by 36% in 71 countries, 3/4th of the rise being in the BRICS countries, not all use have been rational. The situation is worse in the LMICS due to presence of a large informal sector in these countries where the distribution and dispensing of medicines including antibiotics are mostly unregulated and chances of abuse (e.g., inappropriate dose and duration, over use, irregular use etc.) is high. Weak health systems and lack of facilities for basic diagnostics alos condition irrational use of antibiotic in these countries.

On the other hand, lack of access or delayed access to antibiotic is still responsible for large numbers of mortalities and may be a challenge for child survival (under-5 pneumonia deaths are strongly correlated with availability of antibiotics, studies show), among others. In the animal world, more and more antibiotic is used for growth disease prevention instead of making the environment safe through appropriate sanitation measures. In the unregulated environment of the LMICs, the problems are multiplied.

Of late, the issue of AMR has received due recognition as an emergency public health problem and moved up the agenda of global political and health leaders (e.g., the G7 countries and the G7 health ministers).  A Global Action Plan on Antimicrobial Resistance
(http://www.who.int/drugresistance/global_action_plan/en/) has been adopted in October. The first World Antibiotic Awareness Week was observed during Nov 16–22, 2015, with the theme ‘Antibiotics: handle with care.’ Finally, Lancet brought out a Series on ‘Antimicrobials: access and sustainable effectiveness’ on November 2015 (http://www.thelancet.com/series/antimicrobials-access-and-sustainable-effectiveness). In this five articles Series, the authors discuss different aspects of AMR, the Global Plan and possible national actions.


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Rongginn said...

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Dip Choudhury said...

Hi Sir,
Thank you for the insights shared in your blog.
Looking forward to your support .
I am working on the emergency response service for Bangladesh and would request your insights that will help in implementation of an effective EMS in Bangladesh.

Deepankar Choudhury
108 EMS
Shillong Meghalaya