What happens when antibiotics fail? People’s quality of life diminishes and lives are even lost from infections, such as tuberculosis, pneumonia and cholera.
With modern medicine, such infectious diseases would have been easily cured, but the rise of antimicrobial resistance (AMR) has continuously posed a serious health-care problem for decades. AMR is a phenomenon where infectious microorganisms previously susceptible to a certain drug become dangerously resistant to antibiotic treatment.
“This is the ‘vicious cycle’ of AMR. From giving first-line antimicrobials, doctors eventually prescribe last-resort antibiotics. Patients may get better, but we have accelerated the development of drug resistance in the infecting organism,” explained Dr. Eric Tayag, director IV of the Bureau of Local Health Systems Development at the Department of Health (DOH).
In line with its advocacy in battling AMR, leading biopharmaceutical company MSD in the Philippines organized a multisectoral dialogue to increase AMR awareness, share best practices and solutions, particularly in resource-limited settings.
Antibiotic resistance is largely caused by misuse or abuse of antimicrobial drugs—mostly patients undertaking self-prescription or discontinuing medication once they become well. As infectious diseases become more and more fatal, doctors immediately resort to stronger antibiotics for cure.
In the Philippines over 14,000 cases of drug-resistant infections have already been detected in 2015 alone, according to the World Health Organization (WHO). Thus, the DOH launched the Antimicrobial Stewardship (AMS) Program, which brings the strategic framework and advocacy in the fight against AMR closer to health-care professionals and the public.
“The AMS program includes a set of operational tools to help curb the rise of resistance such as the AMS Manual of Procedures, the National Antibiotic Guidelines, and the Antimicrobial Consumption Methods Guide. We have a long road ahead in the battle against antibiotic resistance, but we can find ways to effectively fight this threat together,” Tayag said.
Low-hanging fruit in AMS
In the implementation of AMS, low-resource settings such, as low-income countries particularly face stewardship challenges such as lack of support staff, including infectious diseases specialists, microbiologists and clinical pharmacist; hospital administration support; existing resources or data such as antimicrobial formulary; or fora that engage stakeholders.
As such, the ‘low hanging fruit” approach is used, which is initially selecting the most obtainable targets and prioritizing activities that can be easily rolled out. The Antimicrobial Stewardship Program (ASP) model in South Africa was cited as a learning example of good AMS implementation in resource-constrained settings, with a discussion led by Dr. Adrian Brink, clinical microbiologist of Ampath National Laboratory Services in Milpark Hospital, Johannesburg, South Africa.
In South Africa multidisciplinary teams intervene through “care bundles” or small sets of evidence-based interventions for a defined patient segment and care setting that, when implemented together, results in significantly better outcomes.
Implemented across 47 hospitals in a period of five years, the model employed non-specialized pharmacists because of the lack of infectious diseases resources in the country. The model involved identifying a particular area in the hospital that needs improvement and defining collective goals such as sustainably reducing overall antibiotic consumption by 15 percent. Antibiotic targets were also aligned with local and international guidelines and multidisciplinary ASP communities were formed. The model also called for getting the buy-in of participating institutions, modifying process measures if necessary, and seeking the endorsements of doctors.
In the Philippines collaboration and cooperation among multi-stakeholder groups were also identified as keys to success in the battle against AMR, with the ASP model and best practices in South Africa cited as a “fruitful endeavor” by Dr. Rontgene M. Solante, infectious disease specialist in the country and past president of Philippine Society for Microbiology and Infectious Diseases (PSMID). During 104 weeks of standardized measurement, 116,662 patients on antibiotics were reviewed with 7,934 interventions recorded in South Africa.
Quick wins in AMR
To address AMR in the Philippines, Dr. Solante emphasized the need to expand resources available by spreading awareness and enforcement among health-care professionals, and simplify and standardize the strategies in implementing AMS nationwide.
The common strategies include converting from IV-to-PO (oral) antibiotic therapy as patients get better; facility specific treatment recommendations; dose optimization; deescalation of antimicrobial therapy; and reducing antibiotic therapy to the shortest effective duration.
For its part, MSD in the Philippines is continuously innovating treatment options to address AMR. The company is also bringing the guidelines to patients’ bedside in the form of paper-based protocols in 15 hospitals and the recently launched digitalized protocol called eAMS.
“The battle against AMR is a difficult one. But with integrated efforts from the government and the private sector, patients and doctors, we can preserve our valuable spectrum of antibiotics, develop new drugs that target infections more effectively.
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