Last week, within the text dealing with the misuse and abuse of antibiotics, I had mentioned — among the important considerations — that companion animal caregivers must guard against the unnecessary usage of antibiotics, particularly when our pets are ailing.
This is not an issue that occurs only in Guyana. It is a global problem — needing a global intervention and solution.
Luckily, I came across a paper written by an experienced and registered Pharmacist, Ms. Sandra Khan, Rph, who quite knowledgeably elaborated on this very theme in a document entitled “ANTIMICROBIAL STEWARDSHIP”. With her kind and generous permission, we are reproducing the following tour-de-force text:
The International Pharmaceutical Federation (FIP), a global non-governmental organization with four million members, comprising of pharmacists and pharmaceutical scientists, slated October 28, 2022 to focus on antimicrobial stewardship (AMS). Antimicrobial stewardship is the vigilant and accountable management of agents used to treat suspected microbes (fungi, bacteria, viruses and parasites) that invade and infect the host, whether humans, animals, or plants. Antimicrobial agents include antivirals, antifungals, antibacterials/antibiotics, antiparasitics, biocides and disinfectants.
The question is, why is there such an emphasis to monitor how these antimicrobials are chosen, administered and consumed? The answer lies in your imagination of the world before penicillin (first antibiotic) was discovered in 1928, when mankind was threatened by plagues with no line of defense at hand. Although we currently have a selection of antibiotics from various classes and levels from first generation to Fourth generation, no novel antibiotic has been released. So the pool of reserve is restricted. This is the treatment challenge facing healthcare professionals, to effectively combat established and emerging infections, in spite of resistance to antimicrobial agents.
Antimicrobial resistance (AMR) is caused by the misuse and overuse of antimicrobials where the microbes change over time and no longer respond to the drugs. We have witnessed the challenges of dealing with the variant forms of the COVID-19 virus (alpha, beta, gamma, delta, omicron, and subvariant BA.2). These new drug-resistant pathogens which emerge make it near impossible to treat patients and curb the spread of infections.
The direct and indirect consequences of AMR are exorbitant individual and national costs for higher levels antimicrobials, prolonged hospitalization, disability and, in worst case scenario, death.
FIP partnered with the lead organization, the World Health Organization (WHO), since pharmacists are strategically placed to champion the fight against AMR which is considered one of the top ten global health threats against humanity. FIP does not only focus on policy and advocacy but sent strong signals to the global ministerial meeting, indicating that 144 countries had a national action plan to address AMR.
Centers for Disease Control and Prevention (CDC) indicated that more than half of the antibiotics prescribed in hospitals were inconsistent with the recommended prescribing practices. The following stats released by (CDC) show unjustified prescriptions in the following:
• 79 percent in community acquired pneumonia
• 77 percent of patients with urinary tract infections
• 47 percent of patients who were prescribed fluoroquinolone
• 27 percent of patients prescribed vancomycin injection, the last resort drug
From the practical toolkit done by WHO in 2019 for low- and middle-income countries, the following basic antimicrobial stewardship (AMS) interventions were recommended, building on the existing limited healthcare infrastructural system:
• Education of the involved healthcare workers (prescribers, pharmacists and nurses)
• Design a standardized record system to view all patient medications
• Review rationalization of treatment prescribed against documented indications
• Review treatment prescribed for patients with three or more broad spectrum antibiotics
• Review dosage of treatment
• Review surgical prophylaxis treatments either as a single dose or for a 24-hour period
• Develop and implement standard treatment guidelines for common conditions such as community acquired pneumonia, urinary tract infections, skin and soft tissue infections, surgical prophylaxis, and catheter-related infections
• Identify leadership and expertise in infection management
• Establish a drug and therapeutics committee and ensure continuous availability of essential antibiotics through a robust supply chain management
• Establish basic microbiology laboratory facilities
• Regular surveillance of AMR, AMC and healthcare facilities, and hospital acquired infections
If AMS intervention is already established, the continuous quality improvements are monitored by:
• Setting SMART goals in changing how antibiotics are consumed which are specific, measurable, achievable, relevant and time-bound.
• Establishing a measurement matrix
• Identifying behavioral changes that will be transformative in AMS
AMS must be a coordinated program and designed to meet the need of the citizenry in their unique situations, whether constrained by geographical or economic factors. Hence the framework must have a practical approach, taking into consideration those rare scenarios that might occur.
Antimicrobial management is a tall order and requires a concerted effort from all stakeholders such as the general public, the healthcare professionals (including Veterinarians) relevant professional associations and councils, the governing entities such as the Food and Drugs Department (FDD), as well as the national and international policy makers.
The PET CARE column is indebted to Ms. Sandra Khan for her extensive and incisive comments on the use and abuse of antibiotics — reinforcing the imperative of strengthening the collaborative efforts of all the relevant actors in this ONE HEALTH perspective.
For further discussion/elucidation, you may contact Ms. S. Khan directly at the Medicine Express Pharmacy, 223 Camp Street, N/Cummingsburg.
