Recently, issues on antibiotic resistance (ABR) have taken a centre stage in high-profile global health meetings. ABR, a veritable ticking time bomb, as described by health experts, has potentially adverse ramifications of global proportion and have the capacity of throwing hard-won gains in global health into jeopardy.
Besides its potential threat to global health security, resistance development by disease-causing germs (bacteria, virus, parasites, fungi) towards available and emerging medicines can hobble the control of infectious diseases (HIV-AIDS, TB, malaria, Ebola virus disease etc. non-exempt), drive up the risk of death, as well as healthcare cost. To demonstrate that matters of resistance are not fictional accounts confined only to the world of health experts, malarial endemic regions in the world, including Ghana, have had to make seminally seismic switch from Chloroquine to Artemisinin-Based Combination Therapies, commonly referred to as the ACTs, in the treatment of malaria due to the development of resistance by the malaria parasites.
Having assessed and realised the extent of this global problem and its possible outcome years into the future, it is encouraging to observe that quite a good number of scientific groups, professional organisations, as well as countries, are making fervent responses to a global call for the development of policies and measures to stanch ABR in its course. WHO is already working in collaboration with its partners across many sectors to identify strategies and actions to mitigate ABR. In a gesture of unprecedented political support, on September 18, 2014, President Obama of US signed an Executive Order directing the countries key departments and agencies to take action to combat the rise of antibiotic-resistant bacteria.
In May 2014, the 67th World Health Assembly adopted a resolution on antimicrobial resistance, requesting the Director-General of the WHO to develop a draft global action plan to combat antimicrobial resistance, including antibiotic resistance.
Enacting a national policy
Of note, Ghana prides itself among the few African countries—Kenya and South Africa--currently putting this global scourge on the front burner to a level as far as enacting a national policy to holistically address it.
Locally, Ghana’s response to the call has been as impressive as it should be. In 2013, the Ministry of Health set out to put together a multidisciplinary national Antimicrobial Resistance Working Group of experts well rounded in the field of microbiology, pharmaceutical regulation, research, and professional organisations with the core task of providing technical leadership and support interventions that would enable the containment of antibiotic resistance in the country.
The group is chaired by Mrs Martha Gyansah-Lutterodt, Director of Pharmaceutical Services, Ministry of Health, with the support of ReAct, a network dedicated to mobilising global action on antibiotic resistance with presence in Europe Africa, Asia, Australia, Latin America and North America is steeled to produce policy instruments on the use of antibiotics in the country hopefully by the close of the year.
The overarching aim of the policy, among other things, is to provide guidance on the use of antibiotics by the human and animal health and the agricultural sectors. According to research, the continuous subjection of these precious medicines to misuse and abuse over the years in these sectors has been tremendous, leading to the development of resistant germs.
Routine and untrammelled use of antibiotics for growth promotion in animal husbandry, agriculture and aquaculture is shown to be a major contributory factor favouring emergence and selection of resistant strains of germs. A study conducted as part of the policy development process uncovered that almost every tilapia and poultry sold on and bought from the Ghanaian market contains traces of antibiotics which are apparently used in their production for growth enhancement. The effect of this very practice extends beyond the site of use thereby contributing to environmental contamination, ABR development and dissemination. Since these are the very medicines routinely used in health facilities to treat infections, it is quite disturbing as some local researches show resistance of bacteria to them is fast developing.
Indiscriminate use
Most developed countries have already begun the development and implementation of measures to curb the use of antibiotics in livestock management. Last year in the United States, the Food and Drug Administration--the agency responsible for the country’s medicine regulation--issued guidelines calling on pharmaceutical companies, animal producers and veterinarians to stop indiscriminately using antibiotics that are important for treating humans on livestock.
In Denmark, the drive to preserve antibiotics for human use revolutionised livestock management during the 1990s and 2000s. By 1999, the use of antibiotics in pigs other than curing infections was outlawed—a huge change in a nation that is the world's leading exporter of pork. In most cases, halting the non-medical use of antibiotics in livestock leads to a significant decrease in resistant germs in animals and meat within a year or two according to a 1974 research by a microbiologist, Stuart Levy.
For Ghana to also demonstrate commitment as it joins the growing movement of nations against ABR, the need for similarly painful but necessary policies to be implemented is incumbent as the country cannot afford to be seen as engaging in practices countering the efforts of its partners.
Besides the telling need to change regulations in the use of antibiotics in the agric sector, there is also desperate requirement to make changes in the very sector that critically rely heavily on these drugs to prolong human lives: the health sector. The WHO recommends that health workers can help tackle resistance by enhancing infection prevention and control; prescribing and dispensing antibiotics only when they are truly needed; prescribing and dispensing the right antibiotic(s) to treat the illness.
Ghana is currently on a commendable course in its bid to curb resistance development. However, beyond the enactment of a national policy, a great deal of collective support is needed from every single individual, health professional, regulatory body, livestock farmer etc. to facilitate a successful race against ABR at the policy implementation stage.
The writer is a Senior Pharmacist at Kings Medical Centre, Bontanga-Tamale
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