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  • PMSA EDITORIAL TEAM 2020

Antibiotic Resistance: The Need for more Surveillance in the South Pacific

Author: Macquin Anduwan


Decades of medical advancement is being threatened every day when an antibiotic is wrongly prescribed by a healthcare professional, or dosage unfaithfully taken by patients. Every-day, communicable diseases usually cured by antibiotic coverage may soon become life-threatening. Caesarean sections, dental implants, and a whole range of other procedures may have to be reconsidered with the risk of sepsis in a post-antibiotic world. Thankfully, that day has not arrived yet and many countries around the world have taken initiatives to address this health issue. However, there are concerns that there’s not enough surveillance and research being conducted in the Pacific region. With numerous atolls and island groups with distances of about 5 000 kilometres, regular collection of data is demanding in this part of the world. The concern is that there isn’t enough research and awareness done in the Pacific Community amidst reports that antibiotic use is high and resistance present in this region where communicable diseases are highly prevalent [1], [2].

The discovery of the first antibiotic, as known today, is generally credited to a Scottish scientist by the name of Alexander Fleming in 1928 [3]. He observed that mould found commonly on bread inhibited the growth of bacteria. It wasn’t until later around the 1940s that penicillin became available to the general public when scientists were able to mass produce and refine the drug [3]. Since then, antibiotics have been widely used in the treatment of humans, animals, and agricultural practices [4]. At present, there is substantial concern about the escalating prevalence of antibiotic resistance (ABR) due to overuse and misuse of antibiotics [1], [4].

Antibiotics are antimicrobial agents that interact with bacteria, specifically, to either kill them (bactericidal) or inhibit their growth (bacteriostatic) [5]. When an antibiotic isn’t as efficacious as it should, the bacteria is said to have developed resistance and are able to still flourish under therapeutic levels [3]. Data from around different parts of the world have shown that much of our first-line and last-resort antibiotic options are being reduced [4].

Some species of bacteria are naturally resistant to certain antibiotics. Other bacteria may develop resistance to antibiotics through genetic mutation and/or by acquiring resistance from another bacterium [3].

It is widely believed that overuse of antibiotics is a large influencing factor in antibiotic resistance. The Centers for Disease control and Prevention stated that up to one-third to one-half of antibiotic use in humans is unnecessary or inappropriate [6].

In 2007, a study conducted on the consumption of antibiotics in Samoa revealed an antibiotic consumption rate of 37.3 Defined Daily Doses (DDDs) per 1 000 inhabitants, of which 63% were penicillins [1]. This was a much higher rate in comparison to European countries outpatient antibiotic consumption which varied from 10.0 DDD per 1 000 inhabitants to the highest of 32.2 DDD per 1 000 [1].

Among the Pacific Island Countries and Territories (PICTs) where communicable diseases are commonplace and antibiotics are administered frequently, there is surprisingly a scarcity in research studies conducted on antibiotic use and resistance [7]. The few that have been conducted however, show evidence of antibiotic resistance present and a potential for increase.

An article was released in 2019 where all literature related to ABR in humans in PICTs between 1950 and 2018 were reviewed. In total, sixty-five studies, reports and guidelines met the selection criteria, with most being about Papua New Guinea, Fiji, and New Caledonia. Most (48%) of the studies concentrated on community-acquired infections, while 16% focused on healthcare-acquired infections, and 17% on both [7]. Reports listed community-acquired methicillin resistant S. aureus as the major gram-positive pathogen with rates of resistance ranging broadly between >50% to <20% from the range of isolates tested [7]. Healthcare-associated infections were mainly responsible for gram-negative pathogens, whereas extended spectrum beta-lactamase (ESBL) producing K. pneumoniae isolates were documented in Fiji (22%) and New Caledonia (3.4%) and carbapenem resistant A. baumanni isolates in the French Territories [7].

The study concluded that antibiotic resistance is a problem among the PICTs and that much needs to be done to strengthen surveillance in PICTs so that strategies to contain ABR may be attained [7]. On the other hand, the geographical landscape, limited microbiology laboratory testing facilities, slow internet speeds, and high operational costs provides a logistical and financial challenge in producing robust bacteriology data [2].

Many of the PICTs have already started taking actions to address this issue such as the Solomon Islands rolling out its first antibiotic guidelines in 2015 and Fiji becoming the first country in the Pacific to develop and launch a national plan for antimicrobial resistance in 2018 [8], [9]. With support from the World Health Organization and other non-government organizations (NGOs), the emphasis placed now is on effective surveillance as a key objective in the containment of antimicrobial resistance [2].

Simple practices like completing a prescribed dosage, requesting healthcare providers to avoid prescribing antibiotics when not needed, and good personal hygiene goes a long way in keeping antibiotic resistance in check. Also it would be very beneficial for governments and NGOs, not only in the South Pacific but other regions as well, to ensure healthcare staff are well educated and regular surveillance of ABR monitored to aid planning and implementation of antimicrobial strategies. Antibiotic resistance doesn’t have to be tomorrow’s problem. It’s a concern that needs to be addressed today.

References


[1]

P. Norris and H. A. Nguyen, "Consumption of antibiotics in a small Pacific island nation: Samoa," Pharmacy Practice (Granada), vol. 5, no. 1, 2007.

[2]

N. D. Foxlee, N. Townell and C. L. Lau, "Bacteriology and Antimicrobial Resistance in Vanuatu: January 2017 to December 2019," 2020. [Online]. Available: https://www.semanticscholar.org/paper/Bacteriology-and-Antimicrobial-Resistance-in-2017-Foxlee-Townell/318da2229f0ed6f2790d241a61f7e530ca362697. [Accessed 13 August 2020].

[3]

"About Bacteria & Antibiotics," Alliance for the Prudent Use of Antibiotics, [Online]. Available: https://apua.org/about-resistance. [Accessed 13 August 2020].

[4]

A. S. Chaudhary, "A review of global initiatives to fight antibiotic resistance and recent antibiotics׳ discovery," Acta Pharmaceutica Sinica B, vol. 6, no. 6, pp. 552-556, 2016.

[5]

"Antimicrobial Resistance - Implications for New Zealanders," May 2017. [Online]. Available: https://www.royalsociety.org.nz/assets/documents/Antimicrobial-resistance-factsheet-May-2017.pdf. [Accessed 12 August 2020].

[6]

"Antibiotics: Are you misusing them?," Mayo Clinic, 15 February 2020. [Online]. Available: https://www.mayoclinic.org/healthy-lifestyle/consumer-health/in-depth/antibiotics/art-20045720. [Accessed 12 August 2020].

[7]

N. D. Foxlee, N. Townell, L. McIver and C. L. Lau, "Antibiotic Resistance in Pacific Island Countries and Territories: A Systematic Scoping Review," National Institues of Health, 19 March 2019. [Online]. Available: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6466536/. [Accessed 12 August 2020].

[8]

"Small islands, big step: tackling antibiotic resistance in Solomon Islands," World Health Organization, November 2015. [Online]. Available: https://www.who.int/features/2015/antibiotics-solomon-islands/en/. [Accessed 13 August 2020].

[9]

D. Genchev, "Fiji Launches National Antimicrobial Resistance Action Plan," World Health Organization, 11 October 2018. [Online]. Available: https://www.who.int/westernpacific/news/releases/news-from-the-country/-fiji-launches-national-antimicrobial-resistance-action-plan. [Accessed 13 August 2020].

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