By David Arome
Antimicrobial resistance has recently gained a new global dimension, with Nigeria taking its turn in the emerging public health threat. It is a widespread problem that affects people from all walks of life. Research projections have shown that if the current trend persists by 2050, antimicrobial resistance could likely account for over 10 million deaths per year and US$1 trillion additional healthcare costs globally. Also, US$ 3.4 trillion gross domestic product (GDP) losses per year by 2030. Over the years, microbes have developed varying degrees of resistance to new antimicrobial drugs introduced into the market.
Antimicrobial resistance is a natural process that occurs when microorganisms develop resistance to drugs used to fight them, making infections more difficult to treat and increasing the risk of disease spread, severe illness, and death. Antimicrobial resistance is enhanced by abuse and overuse, as well as inadequate infection prevention and control. The common antimicrobial-resistant pathogens causing infection as reported in different parts of Nigeria are Staphylococcus aureus, fluoroquinolone-resistant, Escherichia coli and resistance among common gram-negative and positive isolates. It is estimated globally that drug resistance accounts for 700,000 deaths each year.
Antimicrobial resistance in humans can be attributed to a variety of factors, majorly to misuse and overuse of antimicrobials, easy access and availability of antimicrobial drugs that can be bought without a doctor’s prescription, and prolonged use of antimicrobial drugs for self-medication, over-prescription with clear indications, and diagnostic uncertainty.
Other factors that contribute to the emergence of antimicrobial resistance include incorrect antimicrobial knowledge among the general population, failure to complete the recommended doses or treatment and significant antimicrobial resistance occurring outside of human medicine, which involves the use of the antimicrobials in food-producing animals and aquaculture.
Also, environmental factors such as lack of clean water and sanitation and inadequate infection prevention and control promote the spread of microbes, some of which can be resistant to antimicrobial treatment. Research has shown that there is a high proportion of tetracycline- and sulphonamide-resistant bacteria and sulphonamide-resistant genes in wastewater treatment plants. All these factors, among others, are contributing to the poor regulatory system in the healthcare system, patients’ negligence on the part of adhering to prescribed regimens, and a lack of awareness of the pending dangers of antimicrobial misuse.
Though the economic impact of this situation is a bit difficult to quantify in real-time, several consequences are linked to it. One of such implication is that resistance can result in higher costs for more expensive antimicrobial drugs, particularly second and third-line drugs, as well as productivity loss and patient death.
Combating the spread of antimicrobial resistance requires a multifaceted approach that includes both global and targeted responses as contained in the World Health Organization’s policy package to combat antimicrobial resistance:
- Strengthen the health regulatory system with guidelines on the sale of antimicrobials in pharmacy stores and medicine stores.
- Harmonization of the antimicrobial resistance surveillance system through the development of agreed-upon epidemiological and microbiological methods; adoption of common definitions to improve the ability to share and compare resistance data; and improved coordination of surveillance networks.
- Community-based approach that is centred on sensitization, awareness creation, and behavioural lifestyle changes to curb the spread of antimicrobial resistance is an instrumental element. Antibiotic misuse and inappropriate antibiotic prescriptions should be reduced through consumer education campaigns, information and training for healthcare professionals, improved diagnostics for treatment decisions, treatment guidelines, and prescription audits.
- Preventing infections through vaccinations is paramount to reducing the need for antibiotics. In addition, innovative approaches are needed for the development of new antibiotics and other products. The introduction of new vaccines may reduce the prevalence of infectious diseases and thereby reduce the need for antibiotics.
- Monitoring of the use of antibiotics in food processing animals should also be looked at, as well as strengthening the surveillance system.
Antimicrobial resistance is a global problem that requires collective action.
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