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Diagnosed of gonorrhoea four years ago, he spent so much money moving from one hospital to another where  antibiotics were prescribed to treat the infection without solution. Antibiotic Reason: David Okon  never completed any of the dosages prescribed by the doctor. It took several months before the  infection  dramatically disappeared. Nobody knew where he picked the infection from. David is not alone in the antibiotic resistance, ABR, crisis. Mr Joseph Ogu also took  ill with  urinary infection and bacteria called escherichia coli, also known as e.coli, escherichia and E.coli resistant to many antibiotics.

It took almost four months and four courses of different antibiotics before the infection was successfully treated. Joseph, 45, felt he had symptoms of a urinary tract infection, but did not pay adequate attention at the time. After a while, he developed a fever and the symptoms of the infection intensified. He consulted his doctor who prescribed  ciprofloxacin, one of the most frequently used antibiotics for urinary tract infections.  But neither the infection nor the fever improved days after.  He was asked to continue with the drug one more week. Joseph later went for urine laboratory test where It was confirmed he had a complicated urinary tract infection and enlarged prostate gland, which was the likely cause of his  fever.

It was also discovered that he was infected with  e.coli, which produced an extended-spectrum beta-lactamase (ESBL) and was resistant to many antibiotics, including ciprofloxacin. The laboratory test result showed that the only antibiotics that Joseph’s infection was sensitive to were amoxicillin/clavulanic acid, trimethoprim-sulfamethoxazole, fosfomycin and a class of last line antibiotics called the carbapenems.  He took the ones prescribed for four weeks. His condition improved, but few days after his treatment was discontinued, he began having fever again and his symptoms of urinary tract infection returned. He went to another doctor who then prescribed the correct dose of fosfomycin for 21 days. His symptoms disappeared  after that and he became well.

The experiences of David and Joseph are  commonplace in Nigeria.  Sadly, the incidence of antibiotic resistance, ABR, and the emergence of multidrug-resistance bacteria are on the increase and they are considered a  major public health issue currently. Antibiotic resistance occurs when bacteria change in response to the use of medicine. First antibiotic The very first antibiotic was penicillin, discovered by Sir Alexander Fleming in 1929. He put disease causing bacteria in a petri-dish and found that penicillium mould inhibited its growth. During World War II, penicillin saved literally thousands of people from death from wound infections. Over the next decades, penicillin and subsequent antibiotics significantly improved the life expectancy of millions, more by effectively treating a wide variety of formerly lethal diseases, such as pneumonia and tuberculosis. Bacteria, not humans or animals, become antibiotic-resistant.

These bacteria may infect humans and animals, and the infections they cause are harder to treat than those caused by non-resistant bacteria.   Antibiotic resistance leads to higher medical costs, prolonged hospital stays  and increased mortality. According to the World Health Organisation, WHO, antibiotic resistance is one of the biggest threats to global health, food security, and development today.  Antibiotic resistance can affect anyone, of any age, in any country.  It occurs naturally, but misuse of antibiotics in humans and animals is accelerating the process.

A growing number of infections – such as pneumonia, tuberculosis (TB), and gonorrhoea, syphilis, chlamydia-are becoming harder to treat as the antibiotics used to treat them become less effective. Only a few months ago, WHO had raised the alarm over the growing threat of  antibiotic resistance. Due to the seriousness of the problem, the world health body  came out with  new guidelines for the treatment of  the three most common sexually transmitted infections (STIs): Chlamydia, gonorrhoea and syphilis, all caused by bacteria and are generally curable with antibiotics.

According to WHO, these STIs are becoming more difficult to treat, with some antibiotics now failing as a result of misuse and overuse, and estimated that, each year, 131 million people are infected with chlamydia, 78 million with gonorrhoea, and 5.6 million with syphilis. The global body maintained that the world urgently needs to change the way it prescribes and uses antibiotics. Although  antibiotics have saved humans from  bacterial disease burden, WHO says even if new medicines are developed, without behaviour change, antibiotic resistance will remain a major threat.

Behaviour change includes actions to reduce the spread of infections through vaccination, hand- washing, practising safe sex, and good food hygiene. “Antibiotic resistance is rising to dangerously high levels in all parts of the world. New resistance mechanisms are emerging and spreading globally, threatening the ability to treat common infectious diseases.

Where antibiotics can be bought for human or animal use without a prescription, the emergence and spread of resistance is made worse. Similarly, in countries without standard treatment guidelines, antibiotics are often over-prescribed by health workers and veterinarians and over-used by the public. Without urgent action, we are heading for a post-antibiotic era, in which common infections and minor injuries can once again kill,” WHO added. Why antibiotic resistance is on the increase in Nigeria Findings have shown that most hospitals in Nigeria have poor ABR systems for bacteria and many  patients have continued to practice  self-medication while some never use their drugs as prescribed by the doctor. According to a former Minister of Health, Prof Onyebuchi Chukwu, there is need for Nigerians to heed the warnings from the public health community about actions that contribute to antibiotic resistance.   The germs that cause disease, Chukwu stated,  develop a defense against drugs because of the way Nigerians use drugs.

“This will render many of the drugs ineffective; for example, those used against malaria and tuberculosis,” he explained. He added that unauthorized vendors of drugs also contribute to the problem. In a report published in the Nigerian Health Watch, a professor of pharmaceutical microbiology at the University of Ibadan, Nigeria and a UK Medical Research Council African Research leader, Iruka Okeke, posited that more patients die of untreatable tuberculosis or drug-resistant typhoid, global health gains are slipping and health budgets fizzling away. According to Okeke, Nigeria’s  health systems are being ripped apart as antibiotic resistance escalates.

Noting that a recent paper in BMC medicine detailing (TB) surveillance in West Africa found that almost a quarter of new TB cases were not susceptible to first line drugs, with Lagos and Ibadan among the highest drug resistance hotspots, he pointed out that the health and financial implications of these findings are tremendous. In  a  2015 study titled:  ‘Surveillance for Antibiotic Resistance in Nigeria: Challenges and Possible Solutions’, Prof. Idris Abdullahi Nasir, Adamu Babyo, Anthony Uchenna Emeribe and Noel Ochada Sani, observed that in Nigeria and other countries where sanitation needs improvement, resistant organisms spread within and between communities with ease.  And in hospitals, when infection control is lax, resistant epidemics thrive. How resistance spreads According to the researchers in the study, resistant bacteria can move from one environment to another (e.g. animal to human or vice versa). Such spread can occur through direct contact (e.g. between animal and human) or indirectly (e.g. in food or water).

Challenges associated with ABR in Nigeria The study showed that although progress has been made in gathering and using ABR data in TB, challenges still remain. It  identified the challenges to include lack of a comprehensive policy and plan to address ABR, weak medicines regulatory capacity and circulation of substandard/counterfeit antibiotics, lack of ABR surveillance strategies, weak laboratory capacity on ABR testing and reporting, lack of essential laboratory reagents and consumables and limited quality assurance and control protocols. According to the study, the medicines supply and distribution systems in most parts of Nigeria are fragmented and weak and the situation increases the opportunities for infiltration of substandard/counterfeit medicines into the supply chain. Inadequate access to basic health services coupled with shortages and frequent stock-out of essential medicines including antibiotics in public health facilities could lead patients to look for other sources usually through illicit sources of supply, which usually deal with substandard/counterfeit medicines.

Although, the WHO Global Strategy for Containment of Antibiotic Resistance recognised laboratory-based surveillance of antibiotic resistance, laboratories in Nigeria are perhaps the most neglected. However, as the world mark this year’s ‘ World Antibiotic Awareness Week ‘ under  the theme: ‘Antibiotics: Handle with care’, health watchers are of the view that to  combat ABR, comprehensive national ABR policies, strategies and plans should be developed and implemented. Urgent and coordinated action is  also  required at all levels to ensure preservation of these life-saving drugs for future utility. Detection of resistance and monitoring the spread requires appropriate laboratory-based surveillance. The Minister of Health, Prof Isaac Adewole, stressed the need to increase awareness and optimize drug quality and use by blocking unsanctioned sales and substandard medicines.

Adewole was also of the view that national surveillance should be enhanced. Individual prevention and control Steps can be taken at all levels of society to reduce the impact and limit the spread of resistance.  To prevent and control the spread of antibiotic resistance, individuals should  use antibiotics  only when prescribed by a certified health professional. People should  also never demand antibiotics if the health worker says they don’t need them. Other measures include resisting the temptation to share or use leftover antibiotics, regular washing of hands,  preparing food hygienically, avoiding close contact with sick people, practising safe  sex, and keeping vaccinations up to date.

Government should, on its side, ensure a robust national action plan to tackle antibiotic resistance is in place, improve surveillance of antibiotic-resistant infections and strengthen policies, programmes, and implementation of infection prevention and control measures, regulate and promote the appropriate use and disposal of quality medicines, and  make information available on the impact of antibiotic resistance.  Meanwhile, health professionals should  always wash their hands, instruments, and ensure the environment  is  clean. They should also prescribe and dispense antibiotics o

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