Prudent use of antimicrobials crucial to overcoming resistance

Izah Azahari

Brunei Darussalam is not exempted from the threats of antimicrobial resistance (AMR) in the form of adverse effects such as incurable infections, increased morbidity and mortality, and increased costs from increased patient care and advanced treatment, including treatment with antimicrobials.

Minister of Health Dato Seri Setia Dr Haji Mohd Isham bin Haji Jaafar shared this in conjunction with World Antibiotic Awareness Week (WAAW) 2020 themed ‘United to Preserve Antimicrobials’.

The message said the danger from AMR requires the effort and commitment of those involved in the use of antimicrobials, which include not only health workers and other stakeholders, but the entire community.

The message added, “In the 20th Century, the first antibiotic called penicillin was discovered. Prior to the introduction of antibiotics, deaths from untreated infections often occurred.

“The discovery of the antibiotic penicillin changed the landscape of medical treatment and was followed by the discovery of other antimicrobial drugs active against various germs, including fungi, parasites and bacteria.

“The group of drugs, collectively referred to as antimicrobials, have shown effectiveness in treating infections, but microbes or germs have been able to show resistance to antimicrobial drugs as a natural response or AMR. For some antimicrobial classes, the phenomenon of antimicrobial resistance increased rapidly once it has been used in humans.

Minister of Health Dato Seri Setia Dr Haji Mohd Isham bin Haji Jaafar. PHOTO: MOH

“Various efforts have been made by global researchers to address this phenomenon using more effective methods with the discovery of a broad spectrum type of antimicrobials.

“However, the rate of discovery of new antimicrobial drugs cannot match the antimicrobial resistance transmission and is only able to address the problem of AMR resistance to a limited extent.”

“The effects of AMR transmission mean that bacteria, fungi and parasites can no longer be fully treated by existing antimicrobial drugs. Thus, the risk of spreading the infection that causes serious illness can result in increased death. Various factors contribute to the uncontrolled increase in AMR. The main factor is the improper or excessive use of antimicrobials and overproduction in the sectors of human health, nutrition and agriculture. In the human health sector, antibiotic abuse may be rampant, especially during the COVID-19 pandemic. The problem of AMR infection transmission is more worrying in underdeveloped countries with the lack of access to clean water and sanitation.

“At the global level, the Global Action Plan to address the problem of AMR was supported at the 68th World Health Assembly in 2015. Among the main objectives of the plan is to cultivate awareness and understanding of AMR through effective communication, education and exercise. WAAW is celebrated every November to increase awareness of universal AMR and to encourage best practices in overcoming the spread and emergence of antimicrobial-capable infections.

“In May, the World Health Organization (WHO), the Food and Agriculture Organization (FAO) and World Organisation for Animal Health (OIE) – known as ‘the Tripartite’ – and other stakeholders held a virtual workshop to discuss ways to further enhance the impact of WAAW. Among the findings from the workshop were the change from ‘antibiotic’ to ‘antimicrobial’, which has a broader and more inclusive meaning; highlighting the importance of ongoing involvement and cooperation from stakeholders; and using more effective communication methods.

“The changes from the meeting were reflected in this year’s WAAW theme, ‘United to Preserve Antimicrobials’, which briefly and comprehensively describes WAAW’s mission. This reflects a shared commitment, not only to combat AMR alone, but towards improving patient safety and the quality of healthcare. The change to this broader term is expected to encourage the involvement of all sectors that use antimicrobials and further foster unity in the approach to health issues in general, or ‘One Health Approach’.

“In raising awareness to address AMR resistance, the public’s role is crucial. Among the things that can be done are taking antimicrobial medication only under a doctor’s supervision, taking a microbial anticoagulant as directed (including dosage and duration of medication), consuming antimicrobial drugs according to the prescribed period on the label of the drug, not sharing the antimicrobial with other people, reducing the risk of infection as a whole by practising hand hygiene, keeping a distance from others when not feeling well, preparing and consuming clean food and water, and getting vaccinated regularly to avoid specific infections.

“Meanwhile, those working in the health sector also have a significant role because efforts to fight AMR can be further enhanced by sharing health knowledge (health literacy) among health professionals and the public about the different types of infections and when antimicrobial drugs can be used.

“In addition, infection prevention measures should also be practised when treating patients, especially patients who have been infected with germs that have resistance to antimicrobials (drug-resistant microorganisms). Good control of the use of antimicrobial (antimicrobial stewardship) should also be practised to prevent the use of antimicrobial is not prudent. This includes good antibiotic prescription practices such as re-examining antimicrobial use and referring to established guidelines.

“With the danger of spreading the AMR phenomenon and the emergence of other infectious diseases, consistent, resilient and united efforts from all are important to overcome the problems that can threaten the health of the country.

“Just as the success achieved in controlling COVID-19 infection in this country thanks to the involvement, cooperation, caring attitude and support from the public and the country’s stakeholders,” the minister said.

“The country will be able to ‘Unite To Preserve Antimicrobials’ by ensuring prudent and correct use of antimicrobials as well as adopting infection prevention measures to overcome global antimicrobial or AMR resistance.”