Antibiotic resistance and cholera


THE emergence of antimicrobial drug resistance (AMR) related to the misuse of antibiotics is a global phenomenon and has been commonly reported.

Anti-microbial resistance (AMR) is the ability of a microorganism such as bacteria to stop antimicrobial agents such as antibiotics from working against it. World over, there is a growing concern over antimicrobial resistance and is currently estimated to be approximately 700,000 new cases annually. It has also been estimated that in the absence of appropriate measures, the progression of antimicrobial resistance will cost millions of lives and trillions of dollars by the year 2050.
One of the major contributing factors to the emergence of the antimicrobial resistance is the indiscriminate use of antimicrobial agents in both humans and animals. A number of types of bacteria that cause serious infections in humans such as cholera, pneumonia and tuberculosis have already developed resistance to most and in some cases all of the available treatments.
Zambia is currently experiencing a cholera outbreak and the urge to self-prescribe and medicate has never been higher. So many people have resorted to what has been termed as cholera prophylaxis using antibiotics such as doxycycline. This has been triggered by the spread of misleading information on social media platforms such as Facebook and WhatsApp. Cholera is a devastating disease that is caused by a gram-negative bacterium called vibrio cholerae. It is usually transmitted through contaminated water or food and is frequently associated with poor sanitation and lack of clean drinking water. The disease is characterised by acute watery diarrhoea, vomiting, muscle cramps, and severe dehydration. The vibrio cholerae has many serogroups, but only toxin-producing serogroups O1 and O139 cause epidemic cholera. The primary treatment for cholera is rehydration with oral or intravenous fluids. For severe cases and certain case by case moderate cases, antimicrobial agents may reduce the volume and duration of diarrhoea. The commonly used drugs include tetracyclines such as doxycycline, fluoroquinolones like ciprofloxacin and macrolides such as clarithromycin.
Over a long period of time, vibrio cholerae remained susceptible to many antibiotics with only 3 percent of the isolates demonstrating resistance as shown in the 1976 worldwide survey. However, recent research reported from several cholera-endemic countries has revealed strains of antibiotic-resistant vibrio. The antibiotics that are resistant include tetracycline, sulphonamides, trimethoprim and gentamicin. Antimicrobial resistance can undermine the success of antimicrobial therapy and resistance makes it possible for these cholera strains to stay longer in the environment and may as such increase the incidence of cholera. Antimicrobial drug resistance can develop through mutations or through the acquisition of resistance genes on the mobile genetic material. Some types of drug resistance are caused by a natural interaction of the vibrio cholerae bacteria with other drug-resistant bacteria in the environment.
To solve the problem of antimicrobial resistance, preventing infections and the spread should be the first step. For example, as in the case of the cholera outbreak, prevention is key. The prevention can be achieved by having a multi-disciplinary and sectoral approach to public health intervention which would include but not be limited to education and the promotion of good hygiene habits. Avoiding infections in the first instance would reduce the amount of antibiotics to be used and reduce the likelihood that resistance will develop during therapy. Vaccines can also be used in the prevention of infections.
There is also need to track and gather data on antibiotic-resistant infections, causes of infections and the risk factors associated with the infections. The information allows experts to develop specific strategies to prevent those infections and prevent the resistant bacteria from spreading.
There is great need to change the antibiotic prescriber and dispensing patterns. According to the World Health Organisation (WHO), up to half of the antibiotics used in humans and in animals are unnecessary and inappropriate. Rational antibiotic use involves mainly the frontline health workers such as community pharmacists to stop the indiscriminate sale of antibiotics. Other health workers such as doctors, clinical officers and nurses should be trained on the proper use of antibiotics to ensure that they are prescribed to patients responsibly. Antimicrobial agents should only be used when they are really needed to treat an infection with the right drug and should be administered in the right way. Regulatory institutions should also be strengthened and should develop ways to monitor the use of antibiotics and restrict their prescription.
Lastly, there is need to develop new drugs and diagnostic tests in order to fight antibiotic resistance. The new drugs can slow down the antibiotic resistance that occurs as part of a natural process as bacteria evolve. Humanity will, therefore, always need new antibiotics to keep up with resistant bacteria, and new diagnostic tests will help track the development of resistance.
Antimicrobial resistance is a global health concern because developing infections can be more severe and difficult to treat. Infections with drug-resistant bacteria such as vibrio cholerae can result in higher case-fatality rates, prolonged hospitalisations, more secondary infections, and increased health care costs. To restrict the development and spread of antimicrobial drug resistance, treatment with antimicrobial drugs should be restricted to patients who really need treatment. Drug resistance is a survival mechanism for bacteria and the problem has no boundaries. We, therefore, need to make use of antibiotics prudently.
The author is a pharmacist and staff development fellow at Copperbelt University. For comments and suggestions email; esco1789@gmail.com


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