What do you do when antimicrobials stop working?
Last week, the world marked Antimicrobial Resistance Awareness (AMR) Week. The goal was to raise awareness about AMR—a phenomenon where antimicrobials no longer kill or prevent the growth of the microbes they used to kill.
Our bodies do an excellent job of containing viral, bacterial, or fungal infections before a doctor chips in with a drug or two to kill the germs and bring us back to good health. These drugs include antibiotics for bacterial infections, antifungals for fungal infections, and antivirals for viral infections.
Unfortunately, some of us don’t go to —or wait for—the doctor to treat actual or presumed infections. We dash to the nearest chemist to buy ampicillin over-the-counter for boils (skin abscesses) and Amoxil for typhoid. Patients who can’t tell the difference between dysentery and diarrhoea would buy branded Ciprofloxacin or Amoxiclav to resolve prolonged toilet troubles and stomach pain. Those who are not that buoyant would manage metronidazole.
Our health practitioners also contribute to the problem. A survey of 12 countries shows that Nigeria has the third-highest percentage of antibiotic prescriptions. Three out of every five patients on admission at our hospitals are on antibiotics. This heavy use of antibiotics contributes to Nigeria’s AMR burden.
The consequence of our use, abuse, and misuse of antibiotics is that the viruses, the bacteria, and the fungi have grown tough —they no longer fear us and our drugs. Our pills and creams are no longer as effective. Regular bacterial infections that were once treatable with first-line antibiotics have become stubborn. You may need a second or third line to treat them. Diseases that needed only Ciprotab now call for Ceftriazone and Imepenem. Diseases that were once tolerable have become debilitating, if not deadly.
The WHO recently spotlighted the story of a woman who had reconstructive facial surgery following an accident. The wound got infected and they treated the infection only for it to rebound and eat away at her face. Gradually, her facial muscles turned to cheese. Further tests showed she had MRSA, the dreaded methicillin-resistant Staphylococcus aureus. Luckily, the woman survived. “If I’d known earlier, maybe I wouldn’t have lost huge portions of my face,” she said years later.
Our ignorance about AMR doesn’t make it any less deadly. About five million people died from drug-resistant infections in 2019. More than one million of these deaths were linked directly to AMR.
Aside from being deadly, AMR is expensive. Infections with drug-resistant bacteria, for instance, mean that patients spend more on higher and more effective antibiotics. These antibiotics don’t come cheap. Augmentin, one of the go-to drugs for severe infections, is now N13,000. That’s more than one-third of the minimum wage.
The task before us is to stem the tide of this menace. The government is playing its part. It has drawn up a national action plan for AMR. The plan seeks to increase awareness about the problem, promote surveillance and research, and improve access to genuine antibiotics. Doctors also have concepts like delayed prescription and antimicrobial stewardship to guide their prescriptions. You can join the fight too.
To join the fight, one, don’t use antibiotics without prescriptions. Second, complete your doses when using prescribed antibiotics. Third, don’t share antibiotics or prescribe them to others. Fourth, have a good hygienic practice. Fifth, get vaccinated. Vaccines protect you from contracting potentially resistant infections or spreading them to others.