In the first two articles of this series, we discussed the magnitude of the problem. We also provided new data that showed that nearly 1.3million people died in 2019 from an antibiotic resistant bacterial disease. Additionally, antibiotic use in childhood is linked to a number of illnesses later on in life.
We also explained how bacteria becomes resistant to antibiotics. This means that the more antibiotics we take, the more resistant we become. This means that we have to resort to last-resort antibiotics for common infections such as cystitis and pneumonia, gonorrhoea and meningitis. Some of these infections are untreatable. We also discussed how this happens in animals, whether they are pets or animals that are used for food.
In this article we will discuss how antibiotics have been misused, misused, and how they are causing harm to our environment.
About one third to one-half of all antibiotics used in humans are found in this country. Unnecessary. Most misuse takes place in primary care. Patients are given antibiotics for viral infections such as the common cold, flu, and bronchitis.
Antibiotics work only against bacterial infections. You can’t fit a square peg in a round hole. When misused, antibiotics can increase resistance and produce unwanted side effects.
The hospital prescribers are also responsible for prescribing antibiotics. unnecessary,Many times, antibiotics are continued for too long. Sometimes, the wrong antibiotic is chosen and the test results are not sent or acted upon.
It is important to choose the right antibiotic. Broad spectrum antibiotics are more harmful to your bacterial ecosystem than narrower spectrum antibiotics. They can also drive resistance in a wider range of bacteria than the less expensive penicillin. This increases your exposure to broad spectrum antibiotics if you don’t send the correct tests or interpret them correctly.
Why is this unnecessary prescribing happening? It is complex. First, many prescribers do a great deal and understand the problem. Others may have different priorities and continue to give poor prescriptions.
There are many reasons why antibiotics are unnecessary. These include the desire to cover all bases no matter how unlikely a bacterial infections is, a lack understanding of antibiotics and the damage they do and wanting to please the patients so they will return (a particular issue in private healthcare), difficulty accessing health care so that the prescriber feels they only have one chance (more common within the public sector) or social pressure when patients insist on getting an antibiotic. A major incentive is that doctors have been paid based on how many prescriptions they wrote in countries like China (not South Africa).
South Africa has another social pressure: an antibiotic prescription is often seen in South Africa as proof of illness. I know of many instances where employers won’t believe that an employee is sick or allow sick time without them having antibiotics.
South Africa also faces another problem: it has a high rate of infectious diseases. This is due to a lack of clean water and sanitation, inadequate vaccination coverage, poverty, and overcrowding.
We also have a large number of people with immunosuppression HIV, TB, and other chronic illnesses. This means that there is a significant burden of people who present for non-bacterial medical care. The more people who visit clinics for any reason, no matter how serious, the more likely they are to be prescribed an antibiotic that is not necessary.
Access to safe sanitation and clean water can reduce the incidence of diarrhoea related to antibiotic-resistant diarrhoea by as much as 60%. ONeill report. Maximizing vaccination coverage to prevent pneumonia could also dramatically reduce antibiotic resistanceUse.
It is important to reduce the social problems that lead to infections as part of the solution for antibiotic resistance. It is difficult to do this in cash-strapped low and middle-income countries, such as South Africa.
Animal health is also a problem area where antibiotics can be misused and abused. Consider companion animals such as your beloved dog or Miss Tiddles. Unnecessary antibiotic use in pets can lead to antibiotic resistant bacteria infections just like it plays out in humans. Because animals also exist in symbiosis, they may need to be treated as well.
Humans and their pets can also exchange bacteria by touching and petting. It is best that Fifi Trixibelle receives an antibiotic only when she requires it.
Another major concern is animal protein production. Different factors can lead to antibiotic misuse in chickens. Many responsible farmers and veterinarians work together to reduce antibiotic use, just like doctors.
However, the animal protein industry is often about fine margins. Therefore, getting animals to market in a short time, at a decent size, and in optimal health is a constant challenge.
Since the 1970s, antibiotics have been added in feed and water to enhance and accelerate growth. South Africa has had a different Act of legislation that allows farmers to buy antibiotic-containing feed without the need for a prescription.
Regular use of antibiotics is also a common way to prevent infections in flocks and herds. Consider this: If you have 30,000 chickens living in a shed and some of them start coughing up, you are not going to take the time to examine each one and treat only those who are showing signs of infection. To prevent infections, antibiotics are often given to animals in bulk.
We are talking about huge quantities. In some countries, as high as 80% of all antibiotics purchased will be used on animals.Food production.
How does antibiotic use in food production animals impact humans? Antibiotic exposure will again drive antibiotic resistance in their intestinal bacteria, with the sensitive ones being largely killed.
Spillage of gut contents onto carcasses can transmit antibiotic resistant bacteria. This can happen if you don’t practice good food hygiene from farm to fork. Good kitchen hygiene is essential when handling animal protein and all types of food, including fruits and vegetables.
Vaccination of food-producing animals is a key method to reducing the risk of infection. It is widely used across all food production systems. For example, the Norwegian salmon fishery reduced the use antibiotics in aquaculture by vaccinating each anaesthetized farmed salmon individually. ClickHereTo see how it is done.
Other infection prevention measures, such as increased space for animals, dietary changes, etc., have also helped reduce the need to use antibiotics. It requires financial commitment, while antibiotics in-feed can be purchased for as little as $10. This is a major reason why antibiotics are not used in low- and middle-income countries.
Even vegetables are affected
I am afraid that you all who eat a plant-based diet are not immune to similar problems.
Antibiotic manufacturers have beenPollutingThe environment has been affected by antibiotics for many decades. When antibiotics are not properly disposed of, it can get into the soil and waterways.
Environmental bacteria are exposed to greater amounts of antibiotics, and the cycle of exposure-advantage-exposure continues, increasing antibiotic resistant bacteria in the environment. They can then be introduced to the food chain by animals or directly to humans.
Many reports have reported thatFruit and vegAntibiotic resistant bacteria at point-of-sale, including tomatoes, lettuce, cucumbers, green beans, sprouts, and others from all parts the world, even here in South Africa.
It should be evident that the pandemic in antibiotic resistant bacterial infection is a multifaceted problem. It is one of the best examples we have of a One Health issue, one that affects both animal and human health.
The only way to reduce the impact this pandemic has to be to intervene to stop the misuse and overuse antibiotics in all three areas. This article will discuss what you can do as an individual to break the cycle and protect your health and that of the public.
Marc Mendelson is Professor of Infectious Diseases and Head of The Division of Infectious Diseases and HIV Medicine, University of Cape Town.
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