Why world leaders must agree on global action
Drug resistance is a major public health problem
By Ogechukwu Agwu
Before the discovery of antibiotics, infections were treated with herbal concoctions. In those days, most diseases whose causative agents have not been discovered, were seen as punishments from the gods. Some diseases had superstitious connotations until most of their causative agents as well as control agents were discovered.
But all that changed when a scientist, Alexander Flemming, discovered the first antibiotic known as Penicillin in 1929, therapy for most diseases were relatively not standardised.The current era of antimicrobial chemotherapy began in 1935 with the discovery of sulphonamides. In 1940, it was demonstrated that penicillin could be an effective therapeutic substance. It was dubbed the magic bullet and a milestone was achieved with its commercial production.
Antibiotics also known as antibacterials are the type of medications that work against infections that are caused by bacteria. There are different types of antibiotics that fight bacteria but they all work in two ways, either as a bactericidal antibiotic or a bacteriostatic antibiotic. Bactericidal antibiotic kills the bacteria by interfering with the formation of the bacterium’s cell or its cell contents; a bacteriostatic antibiotic, however, stops the antibiotic from multiplying. In a layman’s term, antibiotics work either by destroying or slowing down the growth of bacteria.
The United States National Library of Medicine defines “antibiotics as powerful medicines that fight bacterial infections which can save lives when used properly. Antibiotics either stop bacteria from reproducing or kill them.”
Antibiotics are used to treat and prevent some types of bacterial infections; they aren’t active against viral infections such as the common flu. They are prescribed to treat conditions such as severe acne, skin infections like impetigo, and Sexually Transmitted Infections(STIs) like chlamydia and also to speed up recovery from infections like kidney infections.
Antimicrobial resistance a global concern
Since the antibiotic era began, there were instances when bacteria resistance to all existing antibiotics emerged and spread widely until a new antibiotic restored control. The first time was in the ‘50s, when strains of Staphylococcus aureus became resistant to all available antibiotics (tetracycline, chloramphenicol, etc), this raged throughout the hospitals until semi-synthetic penicillins and first generation cephalosporins became available in the ‘60s. Almost complete control was restored by the introduction of gentamicin and other newer aminoglycosides in the early ‘70s, but then lost impact again in the late ‘70s as plasmids encoding aminoglycoside-inactivating enzymes spread widely. The introduction in the early ‘80s of three new classes of agents, third- generation cephalosporins, fluoroquinolones and carbapenems, each initially effective against nearly all gram-negative bacilli, began an unprecedented quarter century in which one or more agents has been available to treat almost any bacterial infection.
Recently, there had been a growing concern amongst medical practitioners as antibacterial resistance increased World Health Organisation(WHO) report states that, “globally, about 480,000 people develop multi-drug resistant TB each year and drug resistance is starting to complicate the fight against HIV and malaria.” The resistance to drugs caused by micro-organisms threatens the effective prevention and treatment of infections caused by parasites, viruses, fungi and bacteria. According to a report , George Osborne , said, “10m people a year could die across the world by 2050 if there is no radical action taken.’ He further said that, ‘antimicrobial resistance to antibiotics will present a greater danger to humankind than cancer by the middle of the century unless world leaders agree on international action to tackle the threat.’
According to WHO, “antimicrobial resistance (AMR) happens when microorganisms such as bacteria, fungi, viruses and parasites change when they are exposed to antimicrobial drugs such as antibiotics, antifungals, antivirals, antimalarials and anthelmintics. AMR microbes are found everywhere, they are found in people, animals, food and the environment. They can spread between people and animals and from person to person. Poor infection control, inadequate sanitary conditions and inappropriate food handling encourage the spread of AMR.”
“Microorganisms that develop antimicrobial resistance are sometimes referred to as superbugs. As a result, the medicines become ineffective and infections persist in the body increasing the risk of spread to others,” the world body said.
Dr Agumah Nnabuife, a lecturer of microbiology at the Ebonyi State University defines “antimicrobial resistance as the resistance put up by microorganisms against antimicrobial agents; in most cases antibiotics. Resistant microorganisms are usually not inhibited or adversely affected by optimal systemic concentrations of antimicrobial agents”
AMR occurs naturally over time usually through genetic changes, also the misuse and overuse of antibiotics can result to one developing resistance to antibiotic. Nnabuife said “Drug resistance in microorganisms can be of genetic or non-genetic origin. Genetically mediated resistance can be transferred from a microorganism to its progeny. In this case inter and intra-species transfer of resistance traits is usually possible.
“Non-genetic origin of drug resistance is usually inherent in an organism and cannot be transferred to another organism. When resistance is non-genetic, it usually results from first line barrier set up by the physiological buildup of the organism. Thankfully, most reported cases of resistance today are of the genetic origin and researches in the field of pharmaceutical microbiology and biotechnology have so far been able to discover a large number of genes responsible for resistance.”
Microbes are developing new mechanisms are emerging and spreading globally, threatening our ability to treat common infectious diseases, resulting in prolonged illness, disability and death. This, according to Nnabuife, is a source of worry ; he explained that patients with infections caused by resistance are at a risk of having worse clinical outcomes and if not managed properly death may follow. In the nearest future, drugs may have no effect if nothing is done about it.
“Microorganisms have highly versatile genetic potentials which help them survive pressure from drugs and enhance their virulence. Owing to their high adaptability and genetic flexibility, microorganisms have over the years devised means of resisting various drugs. They produce enzymes that destroy the drug; an example is the beta-lactamase that destroys penicillin thereby rendering it inactive. Microorganisms have also grown to the stage of altering their permeability, hence having a direct control over drug reception. They also alter the structural target for the drug.
“Profligate use of antibiotics, self-medication and wrong prescription become yardsticks for microorganisms to develop resistance and as such most antibiotics have little or no effect unless they are augmented with other antibiotics.”
Aside from self-medication and wrong use of antibiotics, poor infection prevention and control can increase the spread of drug-resistant infections. Hospitalised patients are one of the main reservoirs of resistant microorganisms. Patients who are carriers of resistant microorganisms can act as a source of infection for others.
“Antibiotics play a critical role in reducing the burden of communicable diseases all over the world. However, the curative power of infectious disease by drugs or drug efficacy is not infinite. Antimicrobial resistance threatens the effectiveness of successful treatment of infections and is a public health issue with national and global dimensions. In low-income countries, AMR frequently occurs in microorganisms that are likely to be transmitted in the community such as organisms causing pneumonia, diarrheal diseases, tuberculosis (TB), sexually transmitted diseases and malaria. Drug resistance has dramatically increased the costs of fighting TB and malaria, and slowed gains against childhood dysentery and pneumonia. It also threatens the push to treat people living with HIV/AIDS effectively. While appearance of drug resistance is a continuous phenomenon in microorganisms, its amplification and spread is through the improper utilisation of antimicrobial agents, the use of fake and counterfeit medicines, poor prescribing habits and non-compliance to prescribed treatments.”
Economic impact of antimicrobial resistance
One reason antimicrobial-drug resistance is of concern is its economic impact, which affects physicians, patients, health-care administrators, pharmaceutical producers, and the general public.
“It is not just a health problem but an economic one, too. The cost of doing nothing, both in terms of lives lost and money wasted, is too great, and the world needs to come together to agree a common approach.” Said Osborne. “Antimicrobial resistance to antibiotics will present a greater danger to humankind than cancer by the middle of the century unless world leaders agree international action to tackle the threat.”
The Institute of Medicine estimates the annual cost of infections caused by antibiotic-resistant bacteria to be U.S.$4 to $5 billion. AMR increases the cost of healthcare with lengthier stays in hospitals and more intensive care required. Without effective antimicrobials for prevention and treatment of infections, medical procedures such as organ transplantation, cancer chemotherapy, diabetes management and major surgery may become a risk.
The way forward
Drug resistance is a major public health problem and also an economic one; it most certainly requires a range of interventions and multidisciplinary team approach. Increasing surveillance and regulating the ways drugs are being dispensed can go a long way to remedy the risk of people developing resistance to treatment, both the primary and public sector should come together to develop national action plans and strengthen their health and surveillance systems so that can prevent and manage AMR.
Nnabuife said, “regulation of drug dispensing practices by government is what I highly advocate, this will reduce the way people abuse drugs, as you know when people begin to overuse drugs their bodies start to develop resistance to the drugs.Most infectious diseases defy almost all forms of treatment because previous infections with the same agents were not properly treated with an effective dose. Also profligate use of antibiotics especially through self-medication should be highly frowned upon as it is relatively a leading cause of antimicrobial resistance.”
“There is also the need to create awareness, a need to enlighten members of the public through health talks, adverts and jingles, we should step up and do more, the people need to know what they face or stand to face should their bodies form any kind of resistance to antibiotics.”
Nnabuife advised that healthcare givers practise professionalism in administration of treatment because a wrong diagnostic step would led to a wrong prescription hence the patient will have to bear the burden which may be financial in case where there isn’t any healthcare plan or insurance for such a patient, this may in turn create an avenue for antimicrobial resistance.
“Professional negligence on the part of the health care givers should be curbed as well because wrong diagnostic protocols usually precede wrong prescription. Wrong diagnosis has been known to pave the way for antimicrobial resistance. Health care givers which include clinicians, dispensing pharmacists, and pharmaceutical industries should ensure that patients are properly informed about the correct dosage of the drug they want to take.”
Monitoring the phenomenon is another way to curb the menace of AMR. This can be done by creating an antimicrobial sensitivity profile in a clinical microbiology laboratory which will help a clinician to proffer proper antibiotic regimen provided the patient strictly adheres to instructions.
Detection of resistance and monitoring its spread requires appropriate laboratory-based surveillance. Thus, to maintain the useful life of antimicrobial agents there needs to be improved access to diagnostic laboratories, improved surveillance of the emergence of resistance, better regulation and better education of the public, clinicians and veterinarians in the appropriate use of antibiotics.
Why you must quit smoking
By Chinenye Molokwu
Smokers crave cigarettes, feel extremely hungry all the time, get irritated often, cough at times, and have concentration related troubles. If that is not enough, then it causes heart disease, increased risk to blindness, artery damage, lung cancer and even a decline in mental function.
Can you muster up the courage to snub cigarettes and quit smoking forever?
If you still need more incentive to end smoking, here are reasons that are surely going to have you change your mind.
There’s a risk of impotency
Puffing cigarettes can stultify a healthy sex life and smokers are highly susceptible to experience erectile dysfunction (ED). Men who are okay to pop up viagra pills need not worry about smoking much.
However, the ones who are worried about the performance in bed should seriously think about quitting. Once you stop smoking, your blood will flow drastically and that will lessen the chances of impotency. Men will get better erections and women will get better orgasms. You can easily cut down the risk of ED once you’ll stop smoking.
Desire younger looking skin?
Who doesn’t want younger looking, healthy skin? Well, if you are a smoker, you surely are ready to compromise with your looks.
Smoking is one thing that wrecks your looks completely. It does a major damage to your appearance and results in the premature development of facial wrinkles. Smoking cessation means no more carbon monoxide blocking the way of oxygen and blood in your body. With the collagen production being back to normal, your skin will get more nutrients, thereby delaying the facial aging and appearance of wrinkles. Quit smoking if you desire to look better.
Smoking invites infection
Researches have shown that the chances of contracting infections caused by pneumonia- causing bacteria are higher for smokers as compared to non-smokers. As smoking can badly damage the protective mucous membrane of one’s respiratory system, it becomes easy for the infection to latch on. Without adequate immunity, the ability to fight infectious organisms is compromised.
Smokers are thereby more prone to a series of severe illnesses that may require hospitalisation at some point of time.
Improve the quality of air you breathe
Within nine months of smoking cessation, you can notice a grave difference in your breathing patterns. As the lung capacity increases by 10% within a short span of time, coughing stops and a person is able to breathe more easily. Lung capacity tends to diminish with age and time. So, in your early 20s or 30s, you wouldn’t be able to notice the effect of smoking until you go for a run. After few years, though the effect of smoking on lungs would become apparent when you would not be able to climb stairs without coughing and wheezing.
Increased risk of macular degeneration
Smokers are four times more susceptible to blindness in the course of time due to age-related macular degeneration when compared to the non-smokers. Nevertheless, quitting can cut down the risk. Age-related macular degeneration is a condition where a loss of central vision occurs. This severe condition causes blindness as it disrupts the part of the retina responsible for activities like reading, driving,or sewing. Smoking is perhaps one of the major causes for this condition.