Nigeria: World Antibiotic Awareness Week - New Health Challenge Emerges With Antibiotics Misuse

21 November 2019

The world is facing a new health challenge due to the misuse of antibiotics which were once wonder drugs for the treatment of infections.

This week, the world marks the World Antibiotic Awareness Week to celebrate the remarkable contribution antibiotics have made to public health, and to also call for action to stop the misuse of antibiotics so as to retain their usefulness.

The call for action is clear - Antibiotics which have helped treat millions of people around the world are losing efficacy at an alarming rate because the bacteria are fighting back and developing resistance to the medicines.

Antimicrobial resistance (AMR) is fast becoming a global challenge and threatens the future use of our precious drugs.

Antimicrobial resistance

Antimicrobial resistance, also known as antibiotics resistance, occurs when microorganisms change in ways and render medication used to cure the infections they cause ineffective. This is the reason why some people complain of persistent infection in spite of using the prescribed antibiotics.

AMR is now a global health emergency as it is mounting pressure on the already vulnerable health system, especially in Nigeria.

The World Health Organisation estimated that 700,000 people die every year due to AMR and that 24 million people will be pushed into poverty globally by 2030.

Also, by 2050, it is estimated that 10 million people will die annually from drug resistance infection, causing $100 trillion in economic losses if efforts are not drastically scaled up to curtail the misuse of antibiotics globally.

The economic costs are set to increase exponentially through productivity losses, prolonged sickness, reduced labour efficiency, and higher hospital bills.

A growing health crisis

A review of an article in the journal Pharmacy and Therapeutics said the first and obvious cause of antibiotic resistance is the misuse and overuse of these drugs.

Some people mistakenly believe that taking any kind of antibiotics is solution to many ailments, and they use these drugs to treat illnesses such as cold, boil, among others.

However, antibiotics can only target and kill bacteria and thus only treat bacterial infections.

AMR is becoming a threat to health security as they affect not just drug-based therapies, but also other health interventions and ability to control infections -common surgeries or stay in the hospital can become fatal in a post-antimicrobial world.

WHO Regional Director for Africa, Matshidiso Moeti, in a statement to commemorate the Week, said AMR is endangering health security and progress towards universal health coverage, by threatening to reverse medical advances of the twentieth century.

Ms Moeti lamented that the treatment of diseases such as pneumonia, tuberculosis, gonorrhea and cancer are becoming difficult because many of these pathogens have become resistant to the first line of antibiotic treatment.

"It also threatens our ability to conduct surgeries and care for premature babies. We are seeing high resistance to common pathogens such as 98 per cent fluoroquinolone-resistant Escherichia coli, meaning there are limited treatment options for people that get this infection," she said.

Ms Moeti urged that patients should only use antibiotics prescribed by certified health professionals as misuse of antibiotics puts us all at risk.

Nigeria

In Nigeria, recurrent outbreaks of communicable diseases such as Lassa fever, meningitis, cholera, diarrhoea among others keeps resurfacing. The resurgence of older diseases such as monkeypox, chickenpox, and yellow fever will become difficult to fight if the country does not take heed.

It is estimated that only half of the antibiotics consumed in Nigeria are correctly used. This poses an imminent threat to disease treatment in the nearest future.

Although there is no available study outlining the full burden of AMR and its health and economic impact on Nigerians, data available from elsewhere and Nigeria-specific data demonstrates that AMR rates of many disease-causing organisms are untenably high in Nigeria.

An epidemiologist with the Nigerian Centre for Disease Control (NCDC), Abidoun Egwuenu, said the situation analysis detected that up to 60 per cent of infections in Nigeria are actually communicable diseases. That means a lot of people actually acquire antibiotics.

Mrs Egwuenu lamented that most people in the country use antibiotics indiscriminately and this is compounded by some health professionals who prescribe drugs without carrying out necessary laboratory tests.

She said that a survey by NCDC found that for every pharmacy licensed to sell antibiotics in Nigeria, there are 15 over the counter medicine stores that are not licensed but still sell them anyway, especially in rural areas.

"... It shows that a lot of antibiotics and other drugs are given even though testing is not provided. Also in the animal health sector, studies conducted found out that up to 55 antimicrobial-resistant persistent in livestock, animals, and food origin and even in the environment. This shows that AMR is everywhere and it is rife and we contribute to increasing prevalence of this problem."

Solution

Mrs Egwuenu said a solution to preserving antibiotics needs to start from everyone including the government, policymakers, regulatory agencies, health workers and the end-user.

She advised that health workers should always follow infection prevention and control practices, and only prescribe and dispense antibiotics when they are truly needed.

She also said the agricultural industry can reduce the use of antibiotics in livestock farming because humans can ingest the residue of the drugs from the animals if it is slaughtered before the antibiotics break down.

"No matter how you cook, fry or boil the animal, the residues are there. So a person keeps taking these antibiotics in suboptimal doses and therefore the infections that are susceptible die off but the ones that are strong start to mutate and change.

"When you give those antibiotics in the right doses, there are already infections that have mutated up to a stage that they can resist those antibiotics, so the person does not get better."

She said NCDC is coordinating with all regulatory agencies especially NAFDAC and Pharmaceutical Council of Nigeria to improve awareness amongst prescribers so that they will not give antibiotics without prescription and doctors will not prescribe without a test

She, however, added that the best way of preventing AMR is through vaccination.

She said there are some vaccines that can help prevent most of the diseases for which people use antibiotics, such as pneumonia, meningitis, tuberculosis, among others.

"When you increase vaccination, you also reduce the instances that people require to get antibiotics because the person has already developed immunity for that infection through the vaccine," she said.

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