Combatting antimicrobial resistance a critical focus for SA’s healthcare sector

When people are prescribed an antibiotic, they expect to, take the medication and get better. However, due to antimicrobial resistance (AMR), the drugs we rely on to treat infections are becoming less effective. This means doctors might have to test several antibiotics before finding one that works—if they find one at all. Sometimes, patients may die from infections that used to be easily treatable a couple of years ago.

This is a dire picture, and it is getting worse. In the next 25 years, around 39 million people could die from drug-resistant infections. That’s more than five times the number of deaths caused by COVID-19 in the past four years, and much higher than the number of deaths expected from cancer.

World Antimicrobial Resistance (AMR) Awareness Week will run from 18-24 November, marking a decade since the global campaign was first introduced to raise awareness on the dangers of AMR. The World Health Organisation ranked antimicrobial resistance as one of the top ten global health threats.  Currently 4.7 million deaths a year are related to AMR. One of the highest occurrences of AMR-related deaths is in sub-Saharan Africa.

I know what antibiotics are, but what are antimicrobials? 

Antibiotics are a type of antimicrobial. Antimicrobials are a collective term for agents that kills microorganisms or stops the organism’s growth. Antimicrobials are grouped into classes based on the organisms that they target e.g., antibiotics that work against bacteria, antifungals that work against fungi, and antivirals that work against viruses.

AMR occurs when certain microorganisms become resistant to antimicrobials making them ineffective. The main factors of resistance are misuses, less effectiveness and lack of new drugs.

Given the prevalence of this issue in our country, Mediclinic Southern Africa is committed to combating AMR through targeted strategies to prevent overprescribing and misuse of antibiotics and by promoting responsible use of antibiotics and other antimicrobials.

Key factors driving AMR in South Africa 

In South Africa, overprescribing and misuse of antibiotics such as use without a valid doctor’s prescription in the out-of-hospital setting plays a major role in the development of AMR.

While antimicrobial resistance affects countries in all regions and people at all income levels, its drivers and consequences are exacerbated by poverty and inequality. Unhealthy environments, lack of access to water, sanitation, and hygiene, for example, enable the spread of infections.

“The lack of access to safe, good quality, and affordable health services limits an individual’s opportunities to make informed choices about behaviours to prevent and manage infections, especially the appropriate use of antibiotics,” says Andriette van Jaarsveld, Clinical Pharmacy Specialist at Mediclinic Southern Africa.

 
Van Jaarsveld says the prevalence of AMR between public and private healthcare patients is very similar because it is the micro-organisms that become resistant, not the person: “This is why the use of every single antibiotic is not only affecting the patient and the patient’s normal flora but also everyone around them and the global community.”    

Impact on public health and outlook in SA

South Africa doesn’t experience challenges accessing antibiotics for general infections, as many of the other sub-Saharan Africa countries do. However, the new antibiotics for multidrug-resistant infections are not always available and when they are, they are very expensive and even difficult to obtain. There were no antibiotics developed in the last 30 years that works in a different way to the existing ones, which is why it is so important to use our current available antibiotics in the best way we could and use it as little as possible.

“We currently have treatment options for most of the multidrug-resistant infections, but when the organisms develop resistance against these treatment options, we will have nothing left to treat these infections with,” says Monique Coetzee, Clinical Pharmacist at Mediclinic Southern Africa. Without effective antimicrobials, any procedure that increases your risk of getting an infection, such as surgery, chemotherapy, and transplants will become extremely risky. 

“We are now progressing into a phase where some specific bacterial infections such as complicated urinary tract infections, caused by certain organisms which we were able to treat easily five years ago, are now becoming multidrug-resistant and very difficult to treat, or in some cases, even impossible to treat,” says van Jaarsveld.

Mediclinic's strategies to mitigate the rise of AMR in South Africa

Mediclinic is aligned with the South African Antimicrobial Resistance National Strategy Framework and supports the global target set at the UN's High-Level Meeting to cut AMR-related deaths by 10% by 2030.

Key initiatives include stricter antimicrobial prescribing policies and participation in global awareness efforts, such as World Antimicrobial Resistance Awareness Week, to educate healthcare providers and the public. Mediclinic emphasises maintaining personal and public hygiene to prevent infections - encouraging regular handwashing, vaccination, and staying home when ill.

Van Jaarsveld concludes with a few simple steps everyone can take to combat the rise of AMR:   

1.     Stop unnecessary prescribing and misuse of antibiotics. Tell your doctor that you only want an antibiotic if it is really necessary.  

2.     Use prescribed antibiotics correctly’

3.     Stay healthy and keep others healthy

a.     Clean your hands by washing with soap and water for at least 20 seconds or using a hand sanitiser that contains at least 60% alcohol.

b.     Cover your mouth and nose with a tissue when coughing or sneezing.

c.     Stay home when you're sick.

d.     Avoid touching your eyes, nose, and mouth with unwashed hands.

e.     Avoid close contact with people who have colds or other upper respiratory infections.

f.      Get recommended vaccines, such as the flu vaccine.