Health agencies warn of dangers of antibiotics overuse

If microbes no longer respond to substances that kill or inhibit them, the smallest infections could become deadly.

That is why Dr Matthew Dryden, lab specialist at the UK Health Security Agency (UKHSA), says antimicrobial resistance (AMR) is a huge concern.

He believes AMR is one of the biggest health hazards that will hit the globe.

During an interview at Carpha Medical Microbiology Laboratory (CMML), Federation Park, Port of Spain, Dryden said the frequent use of antibiotics was making bacteria resistant to the drugs.

“The problem is we have no new classes of antibiotics. So in the not-too-distant future, relatively minor infections, like a wound infection, could spread. There's no antibiotic to treat them, and these things will become life-threatening.

“So these are a major risk to global health. And the countries that are going to suffer most from this are going to be developing, lower- and middle-income countries.”

As a result, the Caribbean Public Health Agency (Carpha) and UKHSA recently joined forces to create the Fleming Fund UKHSA/Carpha project, which was launched on January 14, in collaboration with the British High Commission, to deal with the considerable problem of AMR.

The project will develop AMR surveillance and testing in the region by strengthening laboratory capacity to improve detection and monitoring of resistant micro-organisms, enhancing regional AMR surveillance, and providing workforce training and capacity-building initiatives.

Dr SueMin Nathaniel, acting head of laboratory services, Carpha said, “AMR actually develops in a population of micro-organisms in individuals. So when a person gets sick and takes medicine, some of the bacteria tend to be killed off, but some become resistant due to mutation. And then the mutated bacteria could spread from one person to another or through environmental factors.”

Dr Lisa Indar, acting interim executive director at Carpha, said there was not much legislation in place, so people overuse antibiotics and put them in animal feed and in water as growth promoters for plants.

Dr Horace Cox, acting director of surveillance, disease prevention and control at Carpha, spoke about some of the contributors to AMR.

He said irrational use could occur at the healthcare provider level, as antibiotics were often prescribed without the doctor or pharmacist confirming exactly what illness the patient had. Then there was self-medicating, as, in some jurisdictions, antibiotics could be accessed over the counter.

“Persons self-medicate, they use a lot of antibiotics, and when you do check, the antibiotics are no longer effective in terms of addressing the micro-organisms that they're produced for.”

The quality of antibiotics is also a factor, because, if micro-organisms do not get the correct dosage, it contributes to resistance over time.

“We don't have enough data to see the scope of it at the moment, especially for the Caribbean region. But we know that it's something that exists, and it's because of the threat of it expanding beyond our control and the possible ramifications that we're particularly concerned and we're coming as a partnership.”

Cox said some of those ramifications included a decrease in the possibility of successful health outcomes, leading to people being hospitalised for prolonged periods or death because they were not responding to the antibiotics. Both results also have financial and economic implications for the country and its health system.

“The more antibiotics or antimicrobials that you have resistance to develop, the more you have to become very selective as to the pool that you access in order to treat that particular micro-organism that has infected the patient.

“And that is a very expensive venture, because the pool becomes much narrower, much more difficult to access and very expensive. And these might be more accessible to countries that have a stronger health system. So for the small island developing states, this is a particular concern.”

He said Carpha wanted to get as much data as possible to guide decision- and policy-making, so it was happy to partner with the UKHSA and other key stakeholders to get started.

Dryden said surveillance data showed a lot of resistance in parts of North and Latin America and it was waiting to hit the Caribbean. It would cause a lot of problems in the healthcare system and in the population.

He reiterated Cox’s statement, saying when people get a cold, they ask their doctor for antibiotics and are given the medication. However, most of those types of infections were caused by viruses, which were not controlled by antibiotics.

He said it was important that medical personnel were educated as well, because antibiotics needed to be reserved for true bacterial infections.

Nathaniel said one of the major challenges to getting the data was lab capacity. She said even though member countries did not have the tools to do extensive antibiotics-susceptibility testing, Carpha has seen multi-drug resistance tuberculosis, methicillin-resistant Staphylococcus aureus (bacteria spread from skin to skin contact), Klebsiella pneumoniae (found in intestines), Neisseria gonorrhoeae (gonorrhoea, spread by sexual transmission) and other resistant bacteria.

Dryden added that it was possible other AMRS were in the region, as they were everywhere across the globe, and germs did not need passports to travel.

“The importance of this is to get timely, up-to-date surveillance so we know what's going on on a monthly basis. Then we can see if things are becoming more common or less common, and what the most appropriate intervention is going to be.”

Indar pointed out that Carpha’s responsibility was to protect the health of the region and its many visitors. It also had to work with countries, advocating, influencing and getting their co-operation, which could be a challenge.

So it had discussions with ministers of health and chief medical officers of the region and reports to heads of government to explain the issues being faced as well as the solutions.

HMPV in China not concerning

In late December 2024/early January, there was some panic about the increase in human metapneumovirus (HMPV) cases in China, especially after the devastating covid19 pandemic in 2020.

A January 7 World Health Organization report said, “HMPV is a common respiratory virus found to circulate in many countries in winter through to spring, although not all countries routinely test and publish data on trends in HMPV.

“While some cases can be hospitalised with bronchitis or pneumonia, most people infected with HMPV have mild upper respiratory symptoms similar to the common cold and recover after a few days.”

It said the increase in respiratory-pathogen detections in China was within the range expected for that time of year.

Dryden agreed, saying HMPV was like China’s local flu, so it was not too big of a deal, but he believed it would spread across the globe.

He said UKHSA set up syndromic tests across the world in which a sample of a respiratory illness could be placed in a machine which determined the responsible germ. He recalled a few years ago there was a respiratory outbreak in one part of the world. It was initially thought to be a new covid19 outbreak, but was determined to be HMPV.

“It’s spreading rapidly at the moment in China, because there is a respiratory outbreak, but it’s nothing new.”

Indar added that Carpha recommended member states be on the alert, even as the organisation continued to monitor the situation and analyse data related to fever and respiratory symptoms.

“Because we have a high level of travel, we are monitoring. We have different surveillance systems that monitor travellers’ illness in a very confidential manner, but we react if there is an issue.”

At the moment, Carpha believed the risk was low, but there was potential for an increased risk to the Caribbean.