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The fight against antimicrobial resistance

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The fight against antimicrobial resistance

  • A paper authored by Antimicrobial Resistance Collaborators states that around 4.95 million deaths were associated with bacterial anti microbial resistance in 2019 alone.
  • The paper is an analysis of the burden of AMR, producing estimates for 204 countries and territories, 23 bacterial pathogens, and 88 drug-pathogen combinations in 2019.
  • The six leading pathogens for deaths associated with resistance included E. coli, S. aureus, K. pneumoniae, S. pneumoniae, A. baumannii and Pseudomonas aeruginosa.
  • They have been registered as priority pathogens by WHO.
  • The indiscriminate use of antibiotics, no proper sanitation and the lack of awareness among the public about the dangers of AMR are some of the reasons which need to be tackled in order to fight against antimicrobial resistance.

Global Research on Antimicrobial Resistance (GRAM) report study

  • This study provides a comparative analysis of total human antibiotic consumption worldwide and is represented by a defined daily dose (DDD) WHO metric per 1000 population per day.
  • This corresponds to the percentage of people receiving antibiotics daily (each day of the year) in a particular country.

Main findings:

  • High antibiotic consumption was found in North America, Europe and the Middle East, but very low in sub-Saharan Africa and parts of Southeast Asia.
  • Total antibiotic consumption varied nearly 10-fold from country to country, ranging from 5.0 DDD to 45.9 DDD per 1000 population per day.
  • Estimates included in the paper show that AMR is a leading cause of death globally, higher than HIV/AIDS or malaria.
  • In South Asia, over 389,000 people died as a direct result of AMR in 2019.
  • The death rate was the highest in Western sub-Saharan Africa, at 27.3 deaths per 100,000 and lowest in Australasia, at 6.5 deaths per 100,000.
  • Between 2000 and 2018, global antibiotic consumption increased by 46% (from 9.8 to 14.3 DDD per 1000 population per day).
  • Consumption rates were stable from 2000 to 2018 in high-income countries.
  • In low and Middle income countries, a 76% increase was observed between 2000 and 2018 (7.4 to 13.1DDD per 1000 per day).
  • The largest increases in antibiotic consumption were seen in North Africa and the Middle East (111% increase) and South Asia (116%).
  • Large fluctuations were found in the proportion of antibiotic classes used in different geographic situations.
  • Broad-spectrum penicillin consumption was highest in high-income super regions and lowest in South Asia.
  • In South Asia, fluoroquinolone consumption increased 1.8-fold and third-generation cephalosporins consumption increased 37-fold during the study period.

Antimicrobial resistance (AMR)

  • It is the ability of a microorganism (like bacteria, viruses, and some parasites) to stop an antimicrobial (such as antibiotics, antivirals and antimalarials) from working against it.
  • As a result, standard treatments become ineffective, infections persist and may spread to others.

Multidrug-resistance

  • When an organism is resistant to more than one drug, it is said to be multidrug-resistant.

Causes of antibiotic resistance

  • Antibiotic resistance can happen when bacteria are treated with an antibiotic. The medicine kills most of these germs. But a small group may survive.
  • This might happen in a number of ways.
  • The germs may:
  1. Develop an ability to stop the medicine’s effect
  2. Develop an ability to pump the medicine out of the cell
  3. Change (mutate) so that the medicine no longer works

Concerns about Antibiotic Resistance

  • The discovery of antibiotics less than a century ago was a turning point in public health that has saved countless lives.
  • Although antibiotic resistance develops naturally with normal bacterial mutation, humans are speeding it up by using antibiotics improperly.
  • According to a research, now, 2 million people a year in the US develop antibiotic-resistant infections, and 23,000 of them die of those infections.

Initiatives to deal with Antimicrobial Resistance

Global Action Plan on Antimicrobial Resistance (GAP)

  • In May 2015, World Health Assembly adopted a global action plan on antimicrobial resistance, which outlines five objectives including to improve awareness and understanding of antimicrobial resistance through effective communication, use of antibiotics etc.

Tripartite Joint Secretariat on Antimicrobial Resistance

  • Tripartite organizations established a standing Tripartite Joint Secretariat (TJS) to lead and coordinate the global response to antimicrobial resistance in close collaboration with the UN system and other organizations.
  • The TJS consolidates cooperation between WHO, FAO and OIE drawing on their core mandate and comparative advantages to address the wide range of needs of the global response against antimicrobial resistance.

World Antimicrobial Awareness Week (WAAW)

  • WAAW was previously called World Antibiotic Awareness Week. Since 2020, it has been called World Antimicrobial Awareness Week.
  • This reflects the broadened scope of WAAW to include all antimicrobials including antibiotics, antifungals, antiparasitics and antivirals.
  • Held annually since 2015, WAAW is a global campaign that aims to raise awareness of antimicrobial resistance worldwide and encourage best practices among the general public, health workers and policy makers to slow the development and spread of drug-resistant infections.

Global Antimicrobial Resistance and Use Surveillance System (GLASS)

  • WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to continue filling knowledge gaps and to inform strategies at all levels.
  • GLASS has been conceived to progressively incorporate data from surveillance of AMR in humans, surveillance of the use of antimicrobial medicines, AMR in the food chain and in the environment.

Global Antibiotic Research and Development Partnership (GARDP)

  • A joint initiative of WHO and the Drugs for Neglected Diseases Initiative (DNDi), GARDP encourages research and development through public-private partnerships.
  • By 2025, the partnership aims to develop and deliver five new treatments that target drug-resistant bacteria identified by WHO as posing the greatest threat.

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