Rising antibiotic resistance worries health officials

Health experts in Uganda have warned that the country is seeing worrying increases in the number of deaths and healthcare costs due to drug-resistant infections.

This follows a new study in Uganda and 203 other countries, which indicates that infections with drug-resistant bacteria caused an estimated 1.2 million deaths in 2019, more deaths than HIV/AIDS (690 000) or malaria (409,000) combined.

Drug resistance usually occurs when changes in the infectious agent make drugs less effective. Experts say the overuse and inappropriate use of antibiotics, coupled with the challenge of insufficient access to drugs, is responsible for the emergence of drug-resistant bacteria.

“Antimicrobial resistance or AMR is basically having organisms that cannot be killed by drugs. And it has evolved over time mainly because of the misuse of drugs, especially antibiotics,” said Professor Samuel Majalija, a microbiologist at Makerere University. Sunday monitor.

Dr Andrew Kambugu, director of Makerere University’s Institute of Infectious Diseases (IDI), said AMR is now estimated to “now kill more people than non-communicable diseases”.

He added, “Limited resource settings like Uganda and Africa are places where AMR can thrive because…the control of things like prescribing is not good.

The Ministry of Health is working with the IDI, US Centers for Disease Control (CDC) and other partners to build a better picture of AMR in Uganda.

The next pandemic?
The government said in its antimicrobial resistance work plan for 2018-2023 that “resistance to the most commonly used antimicrobials such as penicillins, tetracyclines, cotrimoxazole, was in some cases over 80%”.

Most worrying is the growing resistance to carbapenems, a last-line treatment for bacterial infections, which ranges from 4 to 30%. The prevalence of bacteria – which are resistant to another commonly used penicillin derivative called methicillin – ranges from 4 to 50%.

The government also revealed that the prevalence of extended-spectrum beta-lactamase (ESBL), a group of bacteria that cannot be killed by penicillin and other common antimicrobials like cephalosphorins, was higher, between 10 and 75% of the samples analyzed.

Health Minister Dr Jane Ruth Aceng acknowledges that while antimicrobial resistance “is not yet a very big problem” in Uganda, its gradual growth is due to “the misuse of antibiotics purchased without a prescription “.

It is a verdict that Professor Nelson Ssewankambo, President of the Uganda National Academy of Sciences (UNAS), agrees with.

UNAS is an organization that has played a central role in assisting the government in developing the antimicrobial resistance work plan.

“The misuse and overuse of antibiotics are major causes of antimicrobial resistance. People just walk into pharmacies and buy antibiotics whether they need them or not,” Prof Ssewankambo said, adding: “They think that because they are coughing they need antibiotics… Pharmacies don’t just distribute the drugs. Why would someone be given antibiotics without a prescription [from a doctor]?”

Dr. Rosemary Byanyima, acting director of Mulago National Referral Hospital, said sometimes medical workers and pharmacists over-prescribe certain drugs because they want to sell or promote certain drugs. Indeed, pharmaceutical companies or their dealers are notorious for penetrating and dominating healthcare systems by “deceiving” and persuading doctors to generously prescribe drugs.

Dr Grace Najjuka, head of the National Microbiology Reference Laboratory (NMRL), says the lab plays a crucial role ‘for patient care’ and ‘antibiotics are used irrationally’ once labs are pushed aside .

Higher death risks
Professor Majalija from Makerere University said the problem of antimicrobial resistance affects both humans and animals, hence the need for a one health approach.

“When a drug is misused in animals, for example, if you give it to chickens, cattle, and dogs, the same bacteria that live in chickens and cattle jump out and go to humans, carrying the same resistance to drugs,” he said. , adding that every effort should be made to ensure that drug-resistant infectious agents do not reach humans.

Dr Byanyima said patients with AMR often spend longer in hospital and need more expensive drugs because cheaper drugs are not effective on them.
“We have a unit where we have a microbiologist. So we do culture and sensitivity [tests to determine the effective medicine for the disease]…we want to study again and see [the burden of drug resistance],” she says.

According to Mr Robin Obura, a lab expert – who does Lira culture and susceptibility testing – they charge between Shs 60,000 and Shs 80,000 per test.

Common illnesses that may not respond to medication include pneumonia due to an infectious agent called Klebsiella pneumoniae.

The health sector performance report for 2020/2021 indicates that it is the second leading cause of death by hospitalization, accounting for 2,944 deaths. Malaria, a disease which Dr Betty Balikagala – in 2019 – found evidence of resistance to the commonly used drug artemisinin, was the leading cause of hospitalizations and deaths in 2020/2021 with 5,017 deaths.

At least 45,042 people died in hospitals in 2019/2020 while in 2020/2021 the number rose to 45,990.
The Uganda AIDS Commission has also reported problems with HIV resistance to antiretroviral therapy.
Dr Najjuka said drug resistance is also very high in Staphylococcus aurous, another common infectious agent, which causes abscesses or swellings and is often found in small wounds on the body.

It revealed that another type of infectious agent, pseudomonas, normally found in critically ill patients, also showed significant levels of drug resistance.

No new antibiotics
Professor Majalija thinks people should exercise caution as the rate at which antibiotics are developed has decreased.

“For the past 20 years, there has been no new antibiotic due to expense and the small global market,” he revealed.

Prof Majalija said that due to AMR some drugs like penicillin became so weak and they were phased out. Amoxicillin, a medicine to treat coughs and bacterial infections, also became “very weak”.

To address the problem of antimicrobial resistance, CDC Country Director Dr Lisa Nelson advises Uganda “to invest[s] in critical capacity… to understand where these threats are going.

She is nevertheless encouraged to observe that Uganda is moving “in the right direction by having a facility accredited by the College of American Pathologists [National Microbiology Reference Laboratory]which can produce internationally recognizable antimicrobial resistance results.

To that end, Dr Byanyima says that Mulago Hospital has “recently… tried to be strict about prescribing habits”.
The Ministry of Health has also set up an antimicrobial committee that responds to empirical data.

“We want to warn our people to take the issue of prescription drugs very seriously and stick to taking the prescribed drugs in the right doses and for the right number of days,” Dr. Aceng concluded.

Can phytotherapy come to the rescue?
Dr Daniel Lule, doctor at Aloesha Organic, a plant [alternative] Kampala Medical Center – told The Sunday Monitor they are seeing many patients who are swapping synthetic drugs for herbal ones.

He cautioned, however, that herbal medicine would not be a soft landing forever as either branch of medicine uses the same ingredients. For now, however, he is happy that “the people who come [for herbal medicine] after the [synthetic] the drugs failed to cure them, are healing.

He adds: “It could be because the molecules of our herbs are different from those of the drugs they were taking.”

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