A growing concern has emerged as one of the top ten global health threats currently facing humanity — Antimicrobial Resistance (AMR). Antimicrobial resistance is a phenomenon in which bacteria, viruses, fungi, and parasites evolve and develop resistance to the drugs that were once effective in treating infections. This resistance occurs primarily due to the overuse and misuse of antimicrobial agents, such as antibiotics and antivirals.

Related: Discovery of a unique bacterial communication system may help to tackle antibiotic resistance

Antibiotics are typically prescribed unnecessarily due to a variety of factors including patient expectations or healthcare provider uncertainty. Incomplete treatment courses can also facilitate the development of AMR. Failure to complete a full course of antibiotics can lead to the survival of tenacious bacteria which could develop resistance mechanisms, rendering future infections untreatable. The over prescription of antibiotics for viral infections where they have no efficacy, such as sore throats or upper respiratory infections are some of the main contributors to the rising threat of AMR.

In parts of the world where antibiotic use is high, this treatment is now futile in more than half of patients. The ASEAN region, specifically, is considered a problem area for AMR, with Malaysia following suit. AMR is expected to affect 4.75 million individuals in Asia alone.

AMR carries profound implications for the immune system

The diminished efficacy of antibiotics faced with resistant bacteria prolongs the battle against infections, placing additional burdens on the immune system. Since infections caused by antibiotic-resistant bacteria tend to persist longer, more effort is required by the immune system to contain them. As AMR continues to spread, healthcare providers have fewer effective antibiotics at their disposal. This limitation can compromise the immune system’s ability to combat infections.

Related: Antibiotics use increases susceptibility to fungal infections

Reducing the unnecessary use of antibiotics is a vital step in slowing down the emergence of resistant bacteria. It is essential for healthcare professionals and patients alike to exercise caution when considering antibiotic treatment, reserving them for situations where they are truly warranted. Additionally, prevention through vaccination, good hygiene practices, and public health measures play a significant role in reducing the burden of infectious diseases.

By promoting a more judicious approach to antibiotic use and emphasizing alternative methods of managing illnesses, we can collectively contribute to the global effort to combat antimicrobial resistance and ensure that antibiotics remain effective for future generations.

Reducing the use of antibiotics to treat common illnesses

To mitigate this crisis, it is crucial to explore alternative methods for managing illnesses that do not rely on antibiotics. Not every illness requires antibiotics, and reducing their unnecessary use can be a powerful strategy in the fight against AMR.

Common Cold and Flu

The common cold and influenza (flu) are viral infections and, therefore, are not responsive to antibiotics. These illnesses are primarily self-limiting, meaning they typically resolve on their own with time and proper care. To manage symptoms, individuals can rest, stay hydrated, and use over-the-counter medications to relieve discomfort. Influenza vaccines are also available to prevent the flu, emphasizing the importance of prevention through vaccination.

Sore Throats

Sore throats are often a byproduct of viral infections, such as the common cold or influenza, where antibiotics have no effect. To address sore throats without antibiotics, consumers should stay hydrated or try non-prescription medications like acetaminophen or ibuprofen to help alleviate throat pain and reduce fever. Lozenges are also an excellent alternative to providing relief from throat discomfort by soothing irritation.

Viral Gastroenteritis

Gastroenteritis, often referred to as the stomach flu, is usually caused by viruses such as rotavirus or norovirus. It does not respond to antibiotic treatment. The key to managing gastroenteritis is rehydration and maintaining electrolyte balance, which can be achieved through oral rehydration solutions. Most cases resolve within a few days without any specific antiviral medications.

Upper Respiratory Tract Infections

Many upper respiratory tract infections, including bronchitis and sinusitis, are often caused by viruses or are self-limited bacterial infections. Antibiotics are not typically needed for these conditions. Instead, symptom relief can be achieved through rest, hydration, and over-the-counter remedies for cough, congestion, and pain. It’s essential for healthcare providers to use diagnostic tests judiciously to determine when antibiotics are truly necessary.

Mild Skin Infections

Minor skin infections, such as small boils or impetigo, are usually caused by bacteria but can often be managed without antibiotics. Proper wound care, including cleaning the affected area and keeping it clean and dry, can help the body’s immune system clear the infection naturally. Topical antiseptics and ointments can aid in the healing process. However, it is essential to consult a healthcare professional for more severe or deep-seated skin infections.

Ear Infections (Otitis Media)

Otitis media, commonly known as an ear infection, is prevalent in children but can occur in adults as well. In many cases, especially in older children and adults, ear infections can resolve without antibiotics. Pain relief and close monitoring may be sufficient, as most ear infections are viral or caused by fluids trapped in the ear. Antibiotics should be reserved for severe or persistent cases or when the infection is bacterial in origin.(Contributed article)

Health Care Asia
Home

A new study from the University of Birmingham has uncovered how patients on heavy antibiotics use are at risk of fungal infection because of disruptions to their immune system. The study involved patients at a UK hospital – patients treated with antibiotics to prevent bacterial infections and sepsis instead developed fungal infections particularly caused by the candida fungus.

Candida infections are generally superficial but in some cases the fungus can enter the bloodstream causing what is known as invasive candidiasis which can be fatal.

A team in the University’s Institute of Immunology and Immunotherapy, in conjunction with US researchers at the National Institutes of Health, discovered that antibiotics disrupted the immune system in the intestines, meaning that fungal infections were poorly controlled in that area. Unexpectedly, the team also found that where fungal infections developed, gut bacteria were able to escape, leading to the additional risk of bacterial infection.

Through animal experiments and analysis of hospital records, the researchers showed that co-infections were likely to occur in humans after they have been treated with antibiotics.

“We knew that antibiotics make fungal infections worse, but the discovery that bacterial co-infections can also develop through these interactions in the gut was surprising,” said Birmingham fellow, Dr. Rebecca Drummond. “These factors can add up to a complicated clinical situation – and by understanding these underlying causes, doctors will be better able to treat these patients effectively.”

The researchers later revealed that treatment with immune-boosting drugs might help counteract the harm of antibiotics in patients in dire need of it.

Read: In plain sight: how your nails can show signs of stress and disease

Health Care Asia Home

Constant use of antibiotics can affect the intestinal microbiome and increase the risk of colon cancer, confirmed researchers at Umeå University, Sweden. According to Sophia Harlid, cancer researcher at the university, although the increase in risk was greatest for those taking a high amount of antibiotics, the Swedish study of 40,000 cancer cases also suggests a small, but statistically significant, increase in the risk of cancer after taking a single course of antibiotics.

[The Swedish study compared data on 40,000 patients from the Swedish Colorectal Cancer Registry from the period 2010-2016 against a matched control group of 200,000 cancer-free individuals drawn from the Swedish population at large. Data on the individuals’ antibiotic use was collected from the Swedish Prescribed Drug Register for the period 2005-2016.]

It was found that both women and men who took oral antibiotics for over six months ran a 17% greater risk of developing cancer in the first part of the colon to be reached by food after the small intestine, than those who did not. The increased risk of colon cancer was visible already five to ten years after taking antibiotics.

Read also: Antimicrobial polymers as alternatives to antibiotics

Surprisingly, no increased risk was observed for cancer in the descending colon; nor was there an increased risk of rectal cancer in men taking antibiotics. However, women taking antibiotics had a slightly reduced incidence of rectal cancer.

The researchers had additionally studied a non-antibiotic bactericidal drug used against urinary infections: there was no difference in the frequency of colon cancer in those who used this drug, highlighting the impact of antibiotics on the gut microbiome was what increased the risk of cancer.

Even intravenous antibiotics may affect the gut microbiota in the intestinal system, the researchers said.

“In many cases antibiotic therapy is necessary and saves lives, [but] in the event of less serious ailments that can be expected to heal anyway, caution should be exercised,” said Harlid.”There is absolutely no cause for alarm simply because you have taken antibiotics. The increase in risk is moderate and the effect on the absolute risk to the individual is fairly small.”

Harlid mentioned that Sweden wascurrently in the process of introducing routine screening for colorectal cancer, important for early detection, prevention, and – sometimes – removal of cancer precursors.

Singapore’s Ministry of Health (MOH) said it is working with the Agri-Food and Veterinary Authority (AVA), the National Environment Agency, and the National University of Singapore (NUS) to develop a nationwide strategy for antimicrobial resistance in the country.

The plan could include educating the public on which illnesses should or should not be treated with antibiotics, and stepping up the monitoring of their use.

Antimicrobial resistance refers to the ability of microbes such as bacteria and viruses to resist the effects of medicines that were previously able to kill them.These microbes develop resistance to antimicrobial medicines when the latter are overused or misused.

Dr. Hsu Li Yang, associate professor and program leader of the antimicrobial resistance program at the Saw Swee Hock School of Public Health in NUS, said: “We are ‘addicted’ to antibiotics – it has become an integral part of human medicine and the livestock industry.”

The more antibiotics a person takes, the more pressure there is for the bacteria to evolve and become resistant, he added.

While the ministry did not provide details of the action plan, it is likely to be close to recommendations made by the World Health Organization (WHO) to tackle antimicrobial resistance.

Besides targeting human medicine, the recommendations also focus on the use of antibiotics in livestock.This could mean examining the use of antibiotics in Singapore’s farms.The AVA currently has a surveillance program which tests for antibiotic residues in locally farmed produce to ensure food safety.

Infectious diseases specialist Paul Tambyah said a comprehensive approach is needed as antibiotics are used far more in agriculture than in human clinics and hospitals.

Bacteria that have become resistant to antibiotics – including those found in livestock – can pass their resistance genes to others in the gut once the meat is consumed, especially if it is not cooked properly.

As for human medicine, Dr.Tambyah said better methods to diagnose ailments are needed so that doctors can target antibiotic treatment at people who actually need it.

The MOH currently has guidelines for doctors on the prescription of antibiotics, although they are not mandatory.

The rise of deadly superbugs rendering even the strongest of antibiotics ineffective is causing widespread concern around the world.

In September, world leaders agreed at the United Nations (UN) General Assembly to develop action plans that would curb the growing problem of antimicrobial resistance.It was only the fourth time in UN history that a health topic was discussed at the assembly, with the Ebola virus being among them.