Abstract
Agrowing public health threat. Resistant microorganisms (i.e. bacteria,
viruses and some parasites) through
genetic mutations become too strong
that they become resistant to the
antimicrobials (i.e. antibiotics, antivirals
1
and antimalarial) over the period.
These microorganisms are present in
our environment, spreading from one
person to another and from animals to
2
human beings.
While a considerable burden of AMR is
suspected, it is difficult to quantify
mortality, disease load and economic
loss related to AMR due to the absence
3
of data in Southeast Asia. AMR causes
prolonged illness, surplus tests, consumption of expensive drugs,
intensive care, compromised surgeries,
chemotherapy, disability and death.
AMR can jeopardize the achievements
of the Sustainable Development Goals
(SDGs).
Resistance is emerging and spreading
globally. Many patients with Klebsiella
pneumoniae had developed resistance
against Carbapenem (last choice for the
treatment of gram-negative bacteria) in
all regions of the world. Patients with
urinary tract infections caused by
Escherichia coli are now resistant to
fluoroquinolone. In at least 10
developed countries of the world, third
generation Cephalosporins are
ineffective against the treatment of
gonorrhea. World Health Organization
(WHO) does not recommend quinolones for the treatment of
gonorrhea anymore and has updated
treatment guidelines for chlamydial and
syphilis infections. Staphylococcus
aureus patients are resistant to first-line
drug i.e. methicillin. Resistance to col istin, the l a st remedy for
Enterobacteriaceae, has been detected.
Alarmingly, extensively drug-resistant
tuberculosis (XDR-TB) and multidrugresistant tuberculosis (MDR-TB) are
types of tuberculosis resistant to no less
than four and two of the key antituberculous drugs respectively have
emerged. XDR-TB has been identified
4
in 105 countries. About 480,000 new
cases of MDR-TB have been estimated
by WHO during 2014. In 2016, around
490,000 people developed MDR-TB
worldwide. Five countries of the
Greater Mekong are now resistant to
the artemisinin-based combination therapies considered as first-line
treatment for Plasmodium falciparum
malaria since 2016. All Anti-Malarial
treatment options for Plasmodium
falciparum are now ineffective along the
Cambodia-Thailand border. About 7%
of patients in developing countries and
10-20% of patients from developed
countries were estimated to have
human immunodeficiency virus (HIV)
resistant to antiretroviral therapy (ART)
in 2010. Antiviral drugs i.e. matrix-2
(M2) inhibitors (Amantadine &
Rimantadine) are now ineffective to
treat the Influenza A virus. Outbreaks of
multidrug resistance Typhoid and sporadic cases of infection with
Ceftriaxone-resistant Salmonella typhi
have been reported in several countries
of the world.
Recently Pakistan's first extensively
drug-resistant (XDR) Salmonella typhi
outbreak (resistant to all antibiotics for
Typhoid) has created an emergency in
the country. The ongoing outbreak had
emerged in the district Hyderabad of
5 Pakistan. In May 2018, the official case
definitions were agreed by the Regional
Disease Surveillance and Response Unit
(RDSRU) in Karachi. Out of the 8,188
Typhoid cases, 5,274 cases of XDR were
reported till December 2018. Among
them 69% of the cases were reported
from Karachi, 27% from Hyderabad
and 4% from other districts of the Sindh
province. Currently, Salmonella typhi in
circulation is resistant to first, second as
w e l l a s t h i r d g e n e r a t i o n C e p h a l o s p o ri n s. C u rr e n t l y,
azithromycin is the only remaining
reliable and cost-effective first-line oral
therapy to manage patients with XDR
Typhoid in low-resource settings.
The risk of XDR Salmonella typhi at the
national level is considered high in
Pakistan due to insufficient unsafe water
supply systems, poor sanitation and
hygiene (WASH) practices, poor infection control mechanisms, inappropriate food-handling, low vaccination coverage and limited
surveillance of Typhoid fever. At the
same time antibiotics are not being
prescribed properly to the humans as
well as animal sector. Furthermore,
AMR confirmatory tests are available
only at major laboratories and tertiary
care hospitals. All these factors have
reduced the ability to track the
occurrence, spread and containment of
XDR Salmonella typhi in Pakistan.
Access to safe water, adequate sanitation, hospital sanitation and cleanliness, hygiene among food
handlers, advocacy, social mobilization,
sensitization of general practitioners/
clinicians, Typhoid conjugate vaccination
and development of new antibiotics are
the most important recommendations
for prevention of the AMR concerning
6-7 XDR Salmonella Typhi in Pakistan.
Besides, strengthening the surveillance
to monitor known resistance, detect
new and emerging trends is the need of
the hour..
Saima Abid. (2019) ANTIMICROBIAL RESISTANCE: UNIVERSAL EMERGENCY, KHYBER MEDICAL UNIVERSITY JOURNAL, Volume 11, Issue 1.
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