Everybody needs to work together to address antibiotic resistance

This article was authored by Judy Bettridge. (Twitter @JudyBettridge)

Not that many years ago, I went to the doctor with a chesty cough that had been hanging around for several weeks.  Normally, I wouldn’t have bothered, but it made cycling to work difficult, so I went to get it checked out. The doctor gave me a course of antibiotics. After a week, I went back to report that they had made no difference to the cough at all. So he offered me a choice – did I want an inhaler or just some more antibiotics? I was rather surprised – surely the choice to take the antibiotics should not rest with me? He was the qualified professional, after all. Responsible antibiotic use was already widely promoted, so why was the medical professional suggesting simply dishing out more of these precious drugs to prolong a treatment that wasn’t working? Maybe he was simply having a bad day, but it seemed to me to show an irresponsible attitude towards the doctor’s role of antibiotic stewardship.

There are many reports of patients putting doctors under pressure to dispense antibiotics, and this is clearly problematic. In many cases, antibiotics are simply not an appropriate treatment and will make no difference to the speed of recovery, especially for viral illness. With widespread media coverage and advertising, many patients are now better informed about the problems of antimicrobial resistance, and that taking unnecessary antibiotics can put them and their families at risk of future infections from antibiotic-resistant bacteria. Doctors are the best-placed to know what is circulating in their local area, and can advise patients when their symptoms are most likely to arise from viral infections – and patients need to be ready to listen and take their advice. However, as my experience shows, doctors may also fall into the trap of anticipating patient expectations for antibiotics where no such pressure exists. Negotiation and understanding between doctor and patient is much more likely to result in satisfaction on both sides – and better compliance with any medication that is prescribed.

Doctors are the best-placed to know what is circulating in their local area, and can advise patients when their symptoms are most likely to arise from viral infections – and patients need to be ready to listen and take their advice.

The very same issues arise in the veterinary profession, with vets and owners or farmers needing to discuss these complex decisions surrounding whether or not antibiotic use is appropriate on a case-by-case basis. Great progress has been made in many areas, especially in eliminating the use of antibiotics as growth promoters in Europe, but there is still much room for improvement. With so much information now available on the internet, it is not uncommon for people to come with very fixed ideas about what is wrong with their animal, and exactly what treatment they want. It is important to remember that many conditions that look the same can have very different causes. The bacteria in our bodies and our environment evolve and change over time, so that even two infections with identical symptoms may be caused by completely different bugs – which need a completely different antibiotic to treat them. For this reason, keeping and reusing antibiotics at a later date is never advisable –especially injectable drugs that can go off within a few weeks of opening. All antibiotics have an expiry date, and using less potent drugs to treat infections is another factor that can encourage antimicrobial resistance to develop.

keeping and reusing antibiotics at a later date is never advisable –especially injectable drugs that can go off within a few weeks of opening

Always check the expiry date of drugs

Where we work in East Africa, as in many other parts of the world, an additional problem is that antibiotic sales and use are frequently unregulated. A lot of commercial animal feed still contains antibiotics – so always check the label and ask the vet or seller if you are in any doubt. Good hygiene in animal production is much better as a preventative, as this can also help reduce viral and parasite infections that will not be helped by in-feed antibiotics in any case. If animals are sick, then involving a vet at an early stage is important to get the right treatment, rather than just buying a drug from an untrained seller and hoping for the best. Especially in remote rural areas, antibiotics may be on sale in the local kiosk, alongside the soap, candles and sweets. These are often human drugs, and so using them in animals is problematic – not only because they are not formulated to give the right dose for that species, but also because there are certain drugs that should simply not be used in animals. This may be because of dangerous residues that pass into the meat, eggs or milk, and so veterinary workers should always advise on how long to leave after treatment before animal products are safe to eat again. If they don’t offer this advice, along with clear instructions on how to use the drugs – ask!  The other reason not to buy antibiotics from unqualified sellers is that there are some drugs that we want to preserve for use in only humans. These critically important antimicrobials are needed to treat difficult and often life-threatening infections in humans that don’t respond to other drugs. Some may be used by vets as a last resort, but their use should always be closely supervised.

Good hygiene in animal production is much better as a preventative, as this can also help reduce viral and parasite infections that will not be helped by in-feed antibiotics in any case.

An antibiotic being administered to a cow

This is why this year’s theme for World Antibiotic Awareness week is “Seek advice from a qualified healthcare professional before taking antibiotics”. Wherever you are in the world, this is sound advice. Advances in science mean that rapid diagnostic tests are coming ever closer, and within a few years, genetic identification not only of the organism causing the infection but also what drugs it is likely to respond to will be possible. This will allow a diagnosis within a few hours, rather than days to weeks it can take with current laboratory methods. Accurate diagnosis, antibiotic selection tailored to every individual case and open discussions between the healthcare professional and the patient or carer as to whether antibiotic use is appropriate in every circumstance are all part of tackling antimicrobial resistance. Whether the healthcare professional is a doctor, nurse, veterinary professional or pharmacist, by making the most of their knowledge to help guide the decision to use antibiotics, everyone can play their part in helping to guard these precious resources for future generations.

Accurate diagnosis, antibiotic selection tailored to every individual case and open discussions between the healthcare professional and the patient or carer as to whether antibiotic use is appropriate in every circumstance are all part of tackling antimicrobial resistance.

World Antibiotic Awareness Week: a look at Kenya

This article was authored by Eric Fevre (Twitter: @EricFevre)

On 14th November, the Kenya Veterinary Association (Twitter @KVANational) hosted a Continuous Professional Development (CPD) event at the Faculty of Veterinary Medicine, University of Nairobi, Kenya.  The Faculty is a collaborator in many of the ZED group’s projects, and recently, we have been awarded funds to develop a joint programme, with a number of other partners, on Antimicrobial Resistance.  Thus, an AMR CPD event, part of #WAAW, was a good opportunity to talk to stakeholders.

The audience consisted of Veterinary Surgeons and Veterinary Paraprofessionals, medical practitioners, scientists, journalists, students and the lay public.  The combined professional experience in the auditorium with the use of antibiotics in the veterinary and medical sectors was enormous, and it was an honour to represent the livestock research agenda at such a gathering, on behalf of both the International Livestock Research Institute and the Institute of Infection and Global Health, University of Liverpool.

The Kenya Medical Research Institute kicked off with an overview of the situation in Kenya – Kenya is far advanced compared with many countries in recognizing the AMR problem, and has, for example, just released its National Action Plan and National Policy (which can be downloaded by clicking here ).  None the less, there are clearly many evidence gaps.

MoALF, CS Dr Tuimur (far left) and Health CS Dr. Cleopa Mailu (immediate far left) launching the World Antibiotic Resistance Awareness Week and Kenya AMR National Action Plan and National Policy

The Food and Agriculture Organization, represented by ex-ILRI Graduate Fellow Stella Kiambi, presented the wider policy view and the FAO approach to AMR.  The National Action Plan itself was presented by the Department of Veterinary Services, followed by two Ministry of Health presentations on the public health impacts of AMR and antimicrobial stewardship.  The NGO World Animal Protection then highlighted the issue from the animal perspective, focused on the impacts of growth promoters and housing on animal welfare. Eric Fèvre then presented a livestock research agenda on AMR in the country, focusing his presentation on the evidence needs for implementing policy on AMR.

This was a very interdisciplinary meeting, co-ordinated and managed by the Kenya Veterinary Association who demonstrably want to play their part in working towards better management and use of antimicrobials, especially in the veterinary sector.  The energy around this issue in Kenya is clear, and there are many opportunities for collaboration and research to provide policymakers with the solid evidence required to implement Kenya’s new National Action Plan.

International One Health Day

International One Health Day, 2017

This blog entry was authored by Matthew Baylis, Principal Investigator-HORN Project

November 3rd is International One Health Day. One Health is the idea that the health of people, animals, plants and the environment are interlinked, and that health will be optimised by different disciplines (such as medicine, veterinary science, social science, economics, environmental science) working together rather than independently. It goes to the heart of multidisciplinarity in science, with large gains to be made by bringing together experts who may approach the similar problems with different skill sets and approaches.

Community members at the Mara being trained about holistic land management to optimize livestock productivity with minimal environmental impact by trainers from the Savory Institute; Photo credit: ZED Group

There are innumerable examples of advances in human medicine that have led to improvements in animal health – as just one example, some of the biggest equipment in the University of Liverpool’s animal clinics (such as MRI scanners) come from human hospitals.  But there are also many examples of veterinary medicine leading to improvements in human health or medicine.  In the UK, we are now safe to eat raw or undercooked eggs owing to a major programme to eliminate salmonellosis from the layer industry. The incidence of human rabies in much of East Africa has declined, owing to vaccination not of people, but of dogs.  My favourite example relates to transmissible spongiform encephalopathies. In the early 1960s members of the Foré tribe in Papua New Guinea were dying from a novel disease called Kuru (related to variant CJD). An American medic attempted transmission experiments with chimps that were not successful, leading to the conclusion that the disease was of genetic origin. The medic spoke on this in the UK and, in the audience, was a veterinarian.  The vet recognised that the characteristics of Kuru seemed identical to that of a sheep disease called scrapie, which had been shown to be transmissible. He alerted the medic, who repeated the experiments, this time successfully, and went on to get the Nobel Prize for Physiology (the medic, not the vet, of course).

A boy keenly reading a vaccination certification after his dog had been vaccinated against rabies; Photo credit: Rabies Free Kenya

Find out more about International One Health Day here: https://www.onehealthcommission.org/en/eventscalendar/one_health_day/

The University of Liverpool is a big player in the area of One Health. We have had a string of large projects in the area of zoonotic diseases and food systems which contribute significantly to non-communicable diseases. Most recently, we have been given a large RCUK-funded Global Challenges Research Fund (GCRF) Growing Research Capability (GROW) award called One Health Regional Network for the Horn of Africa (HORN), which aims to strengthen institutions and train researchers and support staff in areas relevant to One Health in 4 countries of the Horn of Africa: Kenya, Ethiopia, Eritrea and Somalia. It is early days, but you can follow progress here: https://www.facebook.com/groups/1473530819359799/

The One Health Regional Network Logo

Follow us on Twitter: @OneHealthHORN to get our One Health Day updates at the top of every hour today.

Our website, www.onehealthHORN.net (coming soon!)

 

3 Postdoctoral Research Associate positions (to be based in Ethiopia)

Postdoctoral Research Associate Grade 7
Epidemiology And Population Health
008257
£33,518 – £38,833 pa
24-Oct-2017 23:30

3 Postdoctoral Research Associate positions (to be based in Kenya)

Postdoctoral Research Associate Grade 7
Epidemiology And Population Health
008257
£33,518 – £38,833 pa
24-Oct-2017 23:30

Pin It on Pinterest