According to medics, antimicrobial resistance (AMR) is a broader term, encompassing resistance to drugs to treat or cure infections or other microbes as well. These (infections and microbes) include; parasites (like malaria, ascaris, amoeba), and viruses, for example, Human Immunodeficiency Virus (HIV), Hepatitis B (HBV), Hepatitis C (HCV) and fungi (like candida, for example). According to Prosper Dusengeyezu, a public health officer at Rwanda Pharmaceutical Students’ Association (RPSA), AMR happens when one no longer responds to a drug or medicines that previously treated them effectively. For example, he says, if one has a certain condition that was caused by bacteria or any other microorganism, and they go to the health centre, a health care provider will prescribe dispense antimicrobial agents related to the treatment guideline of the infection. He says amoxicillin can be prescribed for such patients, as its commonly antimicrobial agents used in different various treatment of infections. When people use this drug inappropriately, consequently, their body will develop resistance to it, which is a serious health threat. The next time the person suffers from the same condition, the amoxicillin will not be efficient because they would have developed antimicrobial resistance to it. Dusengeyezu says this will require shifting to another line of the treatment, owing to the failure of the first antimicrobial agent. Another example, Dusengeyezu says, if a patient has used coartem several times, and they get sick again, malaria could get worse. Because of AMR, patients will no longer get effective treatment for malaria because their body developed resistance to coartem, therefore, a healthcare professional will necessitate alternate treatment. Dusengeyezu adds that the patient will not be able to be treated by this antimicrobial agent or medicine, and consequently, they will shift to other drugs. Dr Charles Nkuraga, a lecturer at University of Rwanda’s School of Veterinary Medicine and a board member of Rwanda Veterinary Council, says the bacteria, not humans, become antibiotic resistant. He says the bacteria may then infect humans and become harder to treat. He notes that AMR arises when the micro-organisms which cause infection (i.e. bacteria, virus, parasite and fungi), survive exposure to a medicine that would normally kill (lyse) them or stop their growth. He explains that strains that are capable of surviving exposure to a particular drug grow and spread, due to a lack of competition from other strains. He says this has led to the emergence of ‘superbugs’, such as methicillin‑resistant staphylococcus aureus (MRSA) and extremely drug‑resistant tuberculosis, bacteria which are difficult or impossible to treat with existing medicines. According to Word Health Organization (WHO), globally, about 700,000 people die every year from drug resistant strains of common bacterial infections like HIV, TB and malaria. This number is likely to be an underestimate due to poor reporting and surveillance. WHO indicates that nearly 200,000 people die every year from multidrug-resistant and extremely drug resistant tuberculosis alone. WHAT SHOULD BE DONE? Nkuraga says patients often demand antibiotics and other medicines from their doctors, or buy them over-the-counter (OTC) in retail pharmacies, without knowing whether they need them, or understanding the implication of unnecessary use of antimicrobials. He says there is need for a campaign to convince people not to demand antibiotics from their doctor, or buy them OTC in their nearby retail pharmacies without a genuine need like adequate diagnostic. Also, he notes that farmers shouldn’t use them unnecessarily in agriculture owing to drug resistant bacteria in meat and food crops that have exposure to contaminated water. This way, Nkuraga says, disease that affects animals can pass to humans. This, he says, will play an important part in stopping the unnecessary use that is driving so much of the world’s resistance problems. Meanwhile, Othiniel Nimbabazi, Country Representative - Young Professionals Chronic Diseases Network, Kigali, says vaccination has profoundly changed the global infectious disease landscape, saving countless lives and fundamentally shifting patterns of disease transmission. “Promoting development and use of vaccines and alternatives is important as it can help reduce cases of antimicrobial resistance, and it’s less costly as well,” he says. Another point, the medic points out, is that improving sanitation and preventing the spread of infection will help keep the cases of resistance at bay. To reduce unnecessary use of antibiotics and limit the impact of drug-resistant infections, he says the most fundamental steps that can be taken is to break the chain of transmission of infections. “By preventing infections from occurring, we reduce the need for treatment and limit the opportunities for drug-resistant strains to develop,” Nimbabazi adds. Promoting rapid diagnostics is important when it comes to reducing unnecessary use of antimicrobials. In some instances, he says, diagnostic tools are used later to confirm or change that prescription. Nkuraga says there is also need for more people in the human and animal healthcare settings, who are experts in AMR and infectious disease. These, he says, include key frontline personnel such as doctors, nurses, veterinarians, dentists, microbiologists, and epidemiologists among many others. PREVENTING ANTIBIOTIC RESISTANCE Dusengeyezu says the best way to prevent AMR is to always make sure you don’t skip antimicrobial medicine. He notes that it’s also important to share with a healthcare provider your concerns on antimicrobial resistance. In fact, he notes that it’s essential for a patient to ask their healthcare professional if there are steps they can take to feel better and get symptomatic relief without using antimicrobial agents. Also, he notes that taking the prescribed antibiotic as provided by a healthcare professional is as also important. Dusengeyezu adds that it’s important for patients not to save antimicrobial agents or drugs for the next time they get sick. Avoid taking antimicrobial agents prescribed for someone else. He adds that asking your healthcare provider about vaccines recommended for you and your family to prevent infections that may require an antimicrobial agent is important. THE ROLE OF HEALTHCARE PROFESSIONALS Dusengeyezu says it’s important for healthcare professionals to dispense or prescribe an antibiotic or antimicrobials when it is likely to benefit the patient or client. “Prescribing an antibiotic or antimicrobial agent that targets the bacteria that is most likely causing their patients illness is likely to provide benefit,” he says. Also, he points out that inciting patients to use the antibiotic or antimicrobials as instructed is a vital role to ward off AMR in our community. Improving public health awareness campaigns about use of antimicrobials rationally is also necessary as far as preventing cases of AMR is concerned. WHAT TO TAKE INTO CONSIDERATION Experts advise that antibiotics should be the last line of defence NOT the first, and that most common infections will get better by themselves in time. Bed rest, liquid intake and healthy living is also essential. Dusengeyezu says it’s important to only take antimicrobials prescribed by a doctor or pharmacist. If prescribed antimicrobials, he says it’s important for the patient to finish the course. Also, they shouldn’t use other peoples or excess antibiotics. editor@newtimesrwanda.com
