Antimicrobial Resistance

One of the biggest challenges facing health now and into the future is that of antimicrobial resistance, and Monica Lahra from the WHO did a fantastic job at outlining the issue.

Almost 40 years ago the specialty of infectious diseases seemed almost dead as it looked as if mankind had won the battle against microbes. However this was short lived as natural selection ensured antibiotics were no longer our golden bullet. 

Though to some degree antimicrobial resistance is an inevitable consequence of antibiotic use, antibiotic abuse has certainly led the problem to explode throughout the world.  Inappropriate use in hospital, community health facilities, pharmacies and pharmaceutical companies (dumping in water ways) and agricultural practices (fish farms and livestock) have all been the major of drivers of this. Furthermore travel has ensured these organisms are spread throughout the world. For example Poor antibiotic practices have ensured the subcontinent is riddled with ESBL enterobacteriaceae. A survey of Swedish travelers stools before and after returning from the subcontinent showed extremely high carry rates of ESBL after returning to Sweden, often persisting for months. It's tragic to hear now Colistin resistance is being widely seen, particularly in livestock.

So how do we tackle this growing problem? Not easily. Improving awareness and education to healthcare providers so they rationalize and appropriately prescribe antibiotics is key. Restricting over the counter purchasing of antibiotics must accompany this. Increased surveillance and research is also a key to understanding the patterns, distribution and resistance profiles of such organisms. And finally better hygiene practices must continue to be promoted.