North South University Cover Page Department of Public Health Name: Parth Protim Barmon ID No: 1020688080 Course name and code: Directed studies in Public Health PBH 705 Course Taken: Summer 2011 Title of the Research: Impact of Antimicrobial resistance (AMR) in developing countries. Submitted to: Prof. Tahera Ahmed, Part-time Faculty NSU. Length: 5,974 Words Date of Submission: December 30, 2011 Declaration I hold a copy of this research paper that I can produce if the original is lost or damaged. I hereby certify that no part of this research paper or product has been copied from any other student’s work or from any other source expect where due acknowledgement is made in the research. No part of this research paper / product has been written / produced for me by any other person where such collaboration has been authorized by the subject lecture/ tutor concerned. Signature……………… Note: An examiner or lecturer/ tutor have the right not to mark this assignment if the above declaration has not been signed.
34
Embed
Impact of antimicrobial resistance (AMR) in developing countries.
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
North South University Cover Page
Department of Public Health Name: Parth Protim Barmon
ID No: 1020688080
Course name and code: Directed studies in Public Health
PBH 705
Course Taken: Summer 2011
Title of the Research: Impact of Antimicrobial resistance (AMR) in developing countries.
Submitted to: Prof. Tahera Ahmed,
Part-time Faculty NSU.
Length: 5,974 Words
Date of Submission: December 30, 2011
Declaration
I hold a copy of this research paper that I can produce if the original is lost or damaged. I hereby certify
that no part of this research paper or product has been copied from any other student’s work or from any
other source expect where due acknowledgement is made in the research. No part of this research paper /
product has been written / produced for me by any other person where such collaboration has been
authorized by the subject lecture/ tutor concerned.
Signature………………
Note: An examiner or lecturer/ tutor have the right not to mark this assignment if the above declaration
has not been signed.
Title of the study:
Impact of Antimicrobial resistance (AMR) in developing countries.
Back ground of the study:
Antimicrobial resistance (AMR) is resistance of a microorganism to an antimicrobial medicine to
which it was previously sensitive. Resistant organisms (they include bacteria, viruses and some
parasites) are able to withstand attack by antimicrobial medicines, such as antibiotics, antivirals,
and antimalarials, so that standard treatments become ineffective and infections persist and may
spread to others. AMR is a consequence of the use, particularly the misuse, of antimicrobial
medicines and develops when a microorganism mutates or acquires a resistance gene. [10]
Several reports suggest that antimicrobial resistance is an increasing global problem; but like
most pandemics, the greatest toll is in the less developed countries. The dismally low rate of
discovery of antimicrobials compared to the rate of development of antimicrobial resistance
places humanity on a very dangerous precipice. Since antimicrobial resistance is part of an
organism's natural survival instinct, total eradication might be unachievable; however, it can be
reduced to a level that it no longer poses a threat to humanity. While inappropriate antimicrobial
consumption contributes to the development of antimicrobial resistance, other complex political,
social, economic and biomedical factors are equally important. Tackling the hazard therefore
should go beyond the conventional sensitization of members of the public and occasional press
releases to include a multi-sectoral intervention involving the formation of various alliances and
partnerships. Involving civil society organisations like the media could greatly enhance the
success of the interventions.
It is difficult to determine the worldwide prevalence of antimicrobial resistance (AMR); but
several reports suggest that it is an increasing problem of phenomenal proportions, affecting both
rich and poor countries [1-8]
. In 2007, the prevalence of Methicillin-resistant Staphylococcus
aureus (MRSA) ranged from 27.4 to 62.4% and Penicillin-nonsusceptible Streptococcus
pneumoniae from 23.3% to 54.5% in the different census regions of the United States [1]
. In the
UK, enterobacteriacea resistance to cephalosporins is on the increase [2]
, as is the prevalence of
MRSA[3]
in hospital and community settings. The recent report of the European Antimicrobial
Resistance Surveillance System showed a rising prevalence of resistance among the seven
bacterial species (Streptococcus pneumoniae, Staphylococcus aureus, Escherichia coli,
Enterococcus faecalis, Enterococcus faecium, Klebsiella pneumoniae and Pseudomonas
aeruginosa) that serve as indicators for the development of antimicrobial resistance in Europe to
many of the mainline antibiotics [4]
. In India, up to 80% of S. aureus strains are resistant to
penicillin and ampicillin[5]
. Of 3362 pneumococcal isolates collected from 69 centres in 25
countries in the PROTEKT (Prospective Resistant Organism Tracking and Epidemiology for the
Ketolide Telithromycin) study between 1999 and 2000, resistance to Penicillin G was 53.4% in
Asia (overall prevalence), France 46.2%, Spain 42.1% and North Korea 71.5%; resistance to
erythromycin varied from 4.7% in Sweden to 87.6% in South Korea; while resistance to
fluoroquinolones in Hong Kong was 14.3% [6]
. And in South Africa, macrolide resistance and
penicillin non-susceptibility were 54% and 74% respectively [7]
. Chloroquine is almost useless as
an antimalarial in most malaria endemic countries, while MDR-TB and XDR-TB are now
assuming frightening proportions [9]
. While AMR is a growing global problem, like most
epidemics, the greatest toll is usually in the less developed countries. Unfortunately, the rate at
which antimicrobial resistance is developing far outstrips the rate at which new antimicrobials
are being discovered, placing humanity on a very dangerous precipice.
According to WHO (February 2011):
Infections caused by resistant microorganisms often fail to respond to conventional
treatment, resulting in prolonged illness and greater risk of death.
About 440 000 new cases of multidrug-resistant tuberculosis (MDR-TB) emerge
annually, causing at least 150 000 deaths.
Resistance to earlier generation antimalarial medicines such as chloroquine and
sulfadoxine-pyrimethamine is widespread in most malaria-endemic countries.
A high percentage of hospital-acquired infections are caused by highly resistant bacteria
such as methicillin-resistant Staphylococcus aureus (MRSA).
Inappropriate and irrational use of antimicrobial medicines provides favourable
conditions for resistant microorganisms to emerge, spread and persist.
Antimicrobial resistance is a global concern because:
AMR kills
Infections caused by resistant microorganisms often fail to respond to the standard treatment,
resulting in prolonged illness and greater risk of death.
AMR hampers the control of infectious diseases
AMR reduces the effectiveness of treatment because patients remain infectious for longer, thus
potentially spreading resistant microorganisms to others.
AMR threatens a return to the pre-antibiotic era
Many infectious diseases risk becoming uncontrollable and could derail the progress made
towards reaching the targets of the health-related United Nations Millennium Development
Goals set for 2015.
AMR increases the costs of health care
When infections become resistant to first-line medicines, more expensive therapies must be used.
The longer duration of illness and treatment, often in hospitals, increases health-care costs and
the financial burden to families and societies.
AMR jeopardizes health-care gains to society
The achievements of modern medicine are put at risk by AMR. Without effective antimicrobials
for care and prevention of infections, the success of treatments such as organ transplantation,
cancer chemotherapy and major surgery would be compromised.
AMR threatens health security, and damages trade and economies
The growth of global trade and travel allows resistant microorganisms to be spread rapidly to
distant countries and continents. [10]
Inappropriate and irrational use of medicines provides favorable conditions for resistant
microorganisms to emerge and spread. For example, when patients do not take the full course of
a prescribed antimicrobial or when poor quality antimicrobials are used, resistant
microorganisms can emerge and spread.
Underlying factors that drive AMR include:
inadequate national commitment to a comprehensive and coordinated response, ill-
defined accountability and insufficient engagement of communities;
weak or absent surveillance and monitoring systems;
inadequate systems to ensure quality and uninterrupted supply of medicines
inappropriate and irrational use of medicines, including in animal husbandry:
poor infection prevention and control practices;
Depleted arsenals of diagnostics, medicines and vaccines as well as insufficient research
and development on new products. [10]
Research question:
What are the risk factors for Antimicrobial resistance (AMR) in developing countries?
The research will look into the following to arrive at a sound conclusion:
What are the socio- demographic factors associated with higher Antimicrobial resistance
(AMR) in developing countries?
Why developing countries are vulnerable for Antimicrobial resistance?
The role of poverty in antimicrobial resistance
Burden of Antimicrobial Resistance.
.
Literature review:
Antimicrobial resistance (AMR) is an important public health concern shared by developed and
developing countries. In developing countries the burden of infectious diseases is greater and
exacerbated by limited access to, and availability and affordability of, antimicrobials required
treating infections caused by AMR organisms. With drugs not listed on the essential drugs list
(EDL), problems of increased morbidity, costs of extended hospitalization and mortality are
extremely serious. The problem of susceptibility to and spread of infections caused by multidrug-
resistant (MDR) infectious agents is fuelled by factors such as limited access to clean water and
sanitation to ensure personal hygiene, malnutrition, and the HIV/TB epidemic. [12]
In 1990, an estimated 78% of the world's total population lived in the developing world. Of the
39.5 million deaths in the developing world, 9.2 million were estimated to have been caused by
infectious and parasitic diseases. 98% of child mortality occurs in the developing world, due
mainly to infections. Based upon information gathered through searches of the Medline and Bath
Information and Data Services computerized databases, discussions with colleagues, and
personal experiences, the authors consider the progress and impact of bacterial resistance to
antimicrobial drugs in the developing world. While antibiotics are important in developing
countries, they are often scarce commodities which are affordable and therefore available to only
the comparatively wealthy. Because the use of antibiotics is unregulated in many developing
countries, antibiotics are often misused and overused. Such use has provoked the development of
infectious agents which are resistant to antimicrobial drugs, such as strains of pneumococcal
meningitis, tuberculosis, and typhoid fever. Levels of morbidity and mortality are increasing as a
result. Better access to diagnostic laboratories is needed, as well as improved surveillance of the
emergence of resistance, better regulation of antibiotics' use, and better education of the public,
physicians, and veterinarians in the appropriate use of drugs. [11]
According to WHO facts on antimicrobial resistance (February 2011):
About 440 000 new cases of multidrug-resistant tuberculosis (MDR-TB) emerge annually,
causing at least 150 000 deaths. Extensively drug-resistant tuberculosis (XDR-TB) has been
reported in 64 countries to date.
Resistance to earlier generation antimalarial medicines such as chloroquine and sulfadoxine-
pyrimethamine is widespread in most malaria-endemic countries. Falciparum malaria parasites
resistant to artemisinins are emerging in South-East Asia; infections show delayed clearance
after the start of treatment (indicating resistance).
A high percentage of hospital-acquired infections are caused by highly resistant bacteria such as
methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci.
Resistance is an emerging concern for treatment of HIV infection, following the rapid expansion
in access to antiretroviral medicines in recent years; national surveys are underway to detect and
monitor resistance.
Ciprofloxacin is the only antibiotic currently recommended by WHO for the management of
bloody diarrhoea due to Shigella organisms, now that widespread resistance has developed to
other previously effective antibiotics. But rapidly increasing prevalence of resistance to
ciprofloxacin is reducing the options for safe and efficacious treatment of shigellosis, particularly
for children. New antibiotics suitable for oral use are badly needed.
AMR has become a serious problem for treatment of gonorrhoea (caused by Neisseria
gonorrhoeae), involving even "last-line" oral cephalosporins, and is increasing in prevalence
worldwide. Untreatable gonococcal infections would result in increased rates of illness and
death, thus reversing the gains made in the control of this sexually transmitted infection.
New resistance mechanisms, such as the beta-lactamase NDM-1, have emerged among several
gram-negative bacilli. This can render powerful antibiotics, which are often the last defence
against multi-resistant strains of bacteria, ineffective. [10]
Figure. A simplified ARCS diagram showing the close relationship between antimicrobial
resistance containment, disease control and antimicrobial resistance surveillance. [48]