National strategy urged to control antibiotic misuse

IN the light of the highlighted burden of antibiotics resistance, the National Institute of Medical Research (NIMR) has called for a quick national plan to be implemented to control use of antibiotics.

According to the NIMR Director General, Dr Mwele Malecela; Global Antibiotic Resistance Partnership (GARP)- Tanzania -- in its situational analysis reports for antibiotic drug resistance --

recommends that the plan should include reducing the need for antibiotics by reducing the burden of infection through vaccines and general public health measures.

Dr Mwele’s call follows a world Health Organization (WHO) alarm that antibiotic misuse had reached alarming levels globally. Of immediate need, she added, should be the improvement of hospital practices, including infection prevention and control (IPC) and antibiotic stewardship -- and surveillance for antibiotic prescribing and resistance.

In a response to the problem, also contributed to by the NIMR Centre Director at Muhimbili National Hospital, Dr Sayoki Mfinanga, a call has been sounded for the rationalizing of antibiotic use in the community by reducing inappropriate use and expanding access where needed in addition to surveillance of antibiotic prescribing and resistance.

In an interview with the ‘Daily News’, Dr Mwele also called for reduction of antibiotic use in animals by increasing the use of vaccines for preventable infections, eliminating antibiotic use in growth promotion, reducing their use for disease prevention, and conducting surveillance for antibiotic resistance.

“A one-health approach is critical in addressing antibiotic resistance, through educating health professionals, policy makers and the public on sustainable antibiotic use, and ensuring political commitment to meet the threat of antibiotic resistance,” she noted.

Antibiotic resistance to common bacterial diseases is a growing public health problem globally, and especially in African countries in which Tanzania is not exclusive.

Dr Mwele noted that in Tanzania, common bacterial diseases, which need antibiotics, include lower respiratory infections (pneumonia), diarrhoeal diseases bloodstream infections (including typhoid, sepsis, meningitis and bacteremia).

Others are urinary tract infections, sexually-transmitted infections (gonorrhoea and other bacterial infections), and healthcare-associated infections (such as methicillin-resistant Staphylococcus aureus. She added that antibiotic resistance is a natural evolutionary phenomenon that occurs when bacteria are exposed to antibiotics. Every time a person or animal takes an antibiotic, bacteria come in contact with it and chances for mutation or natural variation increases.

“Although even appropriate use could cause resistance but the main cause remains to be inappropriate use of antibiotics,” noted Dr Mwele. NIMR and the National Tuberculosis Control Programme conducted a country representative survey to evaluate drug resistance for first line TB drugs.

The survey involved 1019 new and 148 retreatment patients and showed that Mycobacterium tuberculosis strains resistant to any of the four first-line drugs in new patients was 8.3 per cent, prevalence of multidrug-resistant TB (MDR-TB) was 1.1 per cent while in retreatment patients, the rate for MDR-TB (Multi Drug Resistant Tuberculosis) was 3.9 per cent.

The low levels of drug resistance are likely due to a well-performing TB control programme and the absence of involvement of the private sector in TB treatment. It also indicates that the tight control of TB drugs limiting access only to TB patients has had a positive impact in suppressing drug-resistant strains.

There is no data representative of the whole country in the case of antibiotic resistance for common bacterial diseases. Studies of acute respiratory infections included a study done at the Muhimbili National Hospital in Dar es Salaam by Moyo and others, which was published in 2014 in the journal of Microbial Drug Resistance and involved 285 children under five.

WHO Director Margaret Chan said last week that the rise of antibiotic resistance was a global health crisis. “More and more governments recognise (it is) one of the greatest threats to health today. Resistance was reaching dangerously high levels,” she observed.