By: Minister within the Ministry of Public Health, Dr. Karen Cummings

There must be more responsible use of antibiotics in Guyana

ANTIMICROBIAL medicines are used around the world to treat infections of all types in both animals and humans. Using antimicrobials in a prudent manner is essential to maintaining a healthy population and has allowed many advances in modern medicine. Antibiotics have contributed to many successes in modern medicine, such as the reduction in the death of children under five by pneumonia; reduction in the morbidity and mortality rates due to major surgical interventions and reduction in the mortality rates and the spread of tuberculosis. However, recently, they have been overused by the agricultural and food production industries without consideration of the dire consequences. This lack of consideration has contributed to the problem we are facing today.

Antimicrobial resistance (AMR) has been gradually evolving since the first antimicrobials were used. According to the World Health Organisation (WHO), we are currently facing a global public health crisis, with the increase of antimicrobial resistance. The WHO estimates that unless drastic measures are taken to reduce antimicrobial resistance by 2050, antimicrobial resistance will be the largest killer worldwide, causing the deaths of approximately 10 million people each year

AMR is such a major concern globally that the United Nations General Assembly, for the fourth time since its existence, convened a meeting to discuss the nature of this public health problem. On September 21, 2016, World Leaders made a commitment to “develop national action plans on AMR, based on the “Global Action Plan on Antimicrobial Resistance.”

In May 2014, the World Health Organization developed a global action plan to be implemented in 2017 to reduce the use of antimicrobial agents and control the emergence and spread of resistance. In the Caribbean, availability of data is limited, making it difficult to estimate the frequency of drug resistance in the population and the level of antibiotic use. The lack of data highlights the need for national action plans across the Caribbean.
The Ministry of Public Health and the Ministry of Agriculture collaborated with PAHO to host a very important Antimicrobial Resistance(AMR) consultation meeting to review and discuss the draft AMR National Action Plan for implementation across all sectors in Guyana. Many agencies and programmes have responsibilities in areas affected by AMR. Thus, it is recommended that the most appropriate ways to facilitate and provide synergies with new or existing work is done, so that the overall objectives of the programme are achieved.
The AMR agenda must be appropriately integrated and have clearly defined roles and responsibilities. This plan should spread across the existing health system, public health and disease-specific programmes, animal health and production, and the food sector and environmental initiatives. The cross-cutting nature of this initiative could add value to these systems and programmes.

Since the driver of the increase in antimicrobial resistance has been the overuse and imprudent use of antibiotics across both human and animal health sectors, in both developed and developing countries, the fight against antimicrobial resistance will require a one-health approach across all countries and sectors. It is important that Guyana utilises the multidisciplinary, inter-ministerial approach to realise a tangible reduction in the abuse of antibiotics by 2030. An essential factor that will facilitate the achievement of this goal will also require that Guyana place emphasis on the utilisation of the One-Health model that encapsulates the establishment and maintenance of healthy people, animals and a healthy environment.

How does resistance form? Bacteria and fungi become resistant to antibiotics and antifungals due to over-prescription, improper use of medication and the use of antibiotics in livestock. The more the bacteria are exposed to antibiotics, the more they adapt and become resistant. The abuse of antibiotics through inappropriate use by animal and human health care professionals responsible for the delivery of health care, patients, and even farmers – for the stimulation of growth of animals for human consumption – have led to antimicrobial resistance and the development of what are referred to as “superbugs.”

Unfortunately, the World Health Organization (2016) reported that Tuberculosis “is one of the top 10 causes of death, worldwide. In 2015, 10.4 million people fell ill with TB and 1.8 million died from the disease (including 0.4 million among people co-infected with HIV). Globally in 2015, an estimated 480,000 people developed multidrug-resistant TB (MDR-TB).” By 2020, MDR-TB can contribute to at least 30% of all antimicrobial resistance.

The issue of antimicrobial resistance (AMR) is indeed a global threat, which, if not addressed properly, would endanger the achievement of the Sustainable Development Goals and threaten the very survival of humanity.

Antibiotics are one of the most precious resources available to humans and every effort should be made to preserve them. As we move into the future, let our firm resolve be to handle Antibiotics with tremendous care, and use antibiotics only when prescribed by appropriately registered and certified human or animal care professionals to treat specific bacterial infections.

The Ministry of Public Health will be strongly advocating the appropriate use of antibiotics through public education programmes for health care professionals and the Guyanese population as a whole. The primary objective and national priority of the Ministry of Public Health is to curtail the further emergence and spread of antimicrobial resistance.
During the period November 13 to 19, 2017, Guyana will join the rest of the world to observe Antibiotics Awareness Week, with the theme – Appropriate use of Antibiotics in Sepsis: Timely action that saves lives. On this note, I will call on all Guyanese to pay attention to the alarming threat of antimicrobial resistance and encourage practitioners to be extremely careful in prescribing and dispensing antibiotics to the population.