The discovery of antibiotics is one of the major breakthroughs in the field of medicine. However, bacteria and microbes may start to evolve and become resistant to the antibiotic – as a result, standard treatments become ineffective, infections persist and may spread to others.

Antimicrobial resistance has become a global problem over the years. In 2014, the World Health Organisation (WHO) released a global report on surveillance which addressed the global issue of antimicrobial resistance. WHO stated that over the last 30 years, no major new antibiotic was developed despite many cases of resistance found all over the world.

Then, in March 2015 – at the 68th World Health Assembly – WHO released a global action plan to combat antimicrobial resistance. This issue was brought up again in September 2016, during the United Nations General Assembly held in New York.

The issue in Southeast Asia

There is a lack of epidemiology studies regarding this matter in the southeast region and other regions as well. However, based on studies on selected diseases, this problem has often been neglected and undermined.

Over 30 years ago, gonorrhea could be treated effectively by penicillin. Nowadays, resistance to penicillin and fluoroquinolones is widely increased.

In fact, fluoroquinolones, which targets DNA gyrase and topoisomerase IV of different bacteria to impair DNA replication and cell death, is the backbone of the tuberculosis treatment regimen. Thus, the resistance of Mycobacterium tuberculosis against this particular antibiotic has become a rising concern in the region.

Furthermore, there is also a report that more than 50% of isolated Staphylococcus aureus are resistant to methicillin in hospital settings. In addition, methicillin-resistant Staphylococcus aureus (MRSA) is known as ‘superbug’ due to its multidrug resistance against a number of antibiotics. This makes it one of the common infectious bacteria in a hospital setting.

Causes of antimicrobial resistance

The most common causes of this threat are the overuse and misuse of antibiotics. Antibiotics are meant to treat bacterial infection and not viral infection such as influenza, most of a sore throat and common cold.

However, the overuse of antibiotics in cases will lead to its resistance. This may occur due to patients taking the antibiotic without doctor’s supervision. Sometimes, the doctor may suspect that there is a co-infection, or ‘mistakenly’ establish the viral infection to be a bacterial infection.

Even the therapeutic use of an antibiotic can lead to its resistance – not to mention the non-therapeutic use of antibiotic even in the animal. For example, antibiotics are used in animals to improve feeding efficiency and weight gain. In response to this, the US Food and Drug Administration released a guideline in 2012 that limited the use of antibiotics in animals.

Other causes include improper food handling and poor sanitation. Lack of hygiene in an individual and poor environmental sanitation such as in water supply and sewage disposal system may lead to a spread of antibiotic resistant infection.

Effects of antimicrobial resistance

Once an antibiotic is ineffective in the treatment of infectious diseases, it results in longer duration of treatment, which in turn increases medical costs. In the US, reducing cases of antimicrobial resistance by 20% to 30% will save USD 3.2 to 5.2 billion per year. This is before including the additional savings of USD 11.3 million on reducing the in-hospital days for patients.

More complicated diseases also require a more advanced drug, which will cost more. For example, the drug used for multi-drugs resistant tuberculosis (MDR-TB) is 100 times more expensive than the first line of medications used to treat the disease.

Besides, major procedures such as organ transplantation, cancer chemotherapy, diabetes management and certain surgeries including caesarean sections or hip replacements may be risky, without an effective antibiotic.

This warrants the immediate need of a new type of antimicrobial drug. Recently, WHO released the first-ever list of priority pathogens that were in need of a new antibiotic, by which Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacteriaceae had been placed in Priority 1(critical). MIMS

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