Become an Antibiotic Guardian today

"Change can’t wait. Our time with antibiotics is running out." These warnings herald World Antibiotic Awareness Week (12-18 November 2018) by the WHO, which has declared antibiotic resistance one of the biggest threats to global health, food security and development today.

“And, while antibiotic resistance does occur naturally through genetic changes in the organisms, it’s being accelerated by unnecessary or incorrect use of antibiotics,” says Dr Roshini Moodley Naidoo, Head of Risk Management and Quality of Care at Discovery Health. Since their discovery, antibiotics have served as one of the cornerstones of modern medicine. However, the persistent overuse and misuse of antibiotics in human and animal health have encouraged the emergence and spread of antimicrobial resistance (AMR), which occurs when microbes, such as bacteria, become resistant to the drugs used to treat them. “Misuse refers to antibiotics – meant to treat bacterial infections - being dispensed to patients with viral infections like colds and flu, and when they are given as growth promoters in animals or used to prevent diseases in healthy animals.”

Discovery Health Medical Scheme data show that, between 2008 and 2017, the proportion of in-hospital events accompanied by a claim for antibiotics increased from 48 to 57%. “When it comes to these medications being used out-of-hospital, Discovery Health Medical Scheme has had an average of 1.2 million unique antibiotics related claims each year (January 2015 to June 2018), with an average cost of R440 million claimed each year for these sorts of medications, and an increase of up to 7% in these claims, year-on-year,” says Dr Moodley Naidoo.

Today’s antibiotic are so advanced and widely used, that it’s hard to imagine a time when they were not a standard weapon in a doctors’ bacterial infection-fighting arsenal. Yet, barely a century ago, infections like diarrhoea or pneumonia – today, easily treated - were among the leading causes of death. In 2016, around 700 000 deaths globally were attributed to AMR.

Sam Platt’s sepsis a result of three superbugs

Melissa Platt understands this all too well. She and her husband Fred, founded the Footprints 4 Sam Trust in memory of their son, who was born with Central core disease, a rare muscle myopathy and passed away at 15.5 months old, in 2016. Sam spent all of his life in hospital Intensive Care Units, and eventually passed away from a sudden onset of sepsis, caused by three hospital-induced superbugs - burkholderia, klebisella and pseudomonas. “When a child is in ICU for a long time, and on a ventilator, the nosocomial infection rate is compounded due to the risk of ventilator-acquired pneumonia,” explains Melissa. “Sam was on last-in-line antibiotic Colistin and once he got sepsis there was nothing more that doctors could use to treat him.” Ultimately, this ordeal spurred her on to complete a Postgraduate Diploma in Palliative Medicine (completed cum laude) and Melissa now works as a palliative coach and a professional consultant, focused on the paediatric healthcare sector. She adds: “We are passionate about getting children out of ICU as soon as possible, due to the compounded risk of nosocomial infections.”

Make your Antibiotic Guardian pledge today!

Professor Adrian Brink, a Clinical Microbiologist, serves on the South African Minister of Health's Ministerial Advisory Committee (MAC) on AMR, has secured sponsorship from Public Health England (PHE) who, via the British Society for Antimicrobial Chemotherapy, will host South Africa's first ever AMR online awareness campaign.

"By pledging their commitment online and becoming 'Antibiotic Guardians', medical scheme members and members of society at large can choose from a list of pledges – simple actions - that they can practice, to prevent the over-use of antibiotics, so keeping these drugs viable," explains Prof. Brink.

Dr Diane Ashiru-Oredope, Pharmacist Lead for the Antimicrobial Resistance programme at PHE and lead co-coordinator for the Antibiotic Guardian campaign for SA, says in this regard: "Everyone can play a part in tackling antibiotic resistance. We often hear about the problem of these vital drugs becoming ineffective, but not about what actions individuals can take to help – this is exactly what the Antibiotic Guardian campaign provides."

BRICS countries share a considerable vulnerability to AMR

“In the absence of a solution, AMR could, by 2050, cause 10 million deaths a year – far more deaths than cancer causes today,” says esteemed British Economist, Lord Jim O’Neill, who was a speaker at the 9^th Discovery Leadership Summit held on 1 November in Sandton, Johannesburg. He’s also the creator of the “BRIC” acronym ( a grouping referring to leading emerging economies Brazil, China, Russia and India - and in 2010, South Africa joined what is now known as “BRICS”). In 2014, Lord O’Neill was tasked by former UK Prime Minister, David Cameron, to establish and chair a Review into AMR analyse the global problem of rising drug resistance. The purpose was also to propose concrete actions to tackle AMR.

O’Neill explains: “The BRICS countries share a considerable vulnerability. One third of global AMR-linked deaths could stem from Multi Drug Resistant Tuberculosis alone. We must intervene urgently, otherwise the BRICS countries will never reach their potential. South Africa has played a key leadership role in giving a voice to this global threat. If not for South Africa’s leadership around AMR within the BRICS countries, this theme would not have been on the G20 agenda. Leading surveillance research on AMR is being done in South Africa by institutions like the University of Cape Town and others.”

Global health crisis, made worse by unnecessary or incorrect use of antibiotics

“When bacterial infections become resistant to first-line antibiotics, more expensive medicines are needed to fight them. Also, illnesses and treatments last longer, increasing healthcare costs as well as the economic burden on families and societies,” says Dr Moodley Naidoo. “People with these infections are at greater risk of death. So-called ‘superbugs’ are near impossible, or impossible, to treat. Alarmingly, organ transplants, chemotherapy and surgeries become much more dangerous without effective antibiotics for the prevention and treatment of infections.”

Who is at risk of contracting so-called superbugs? “Patients with weak immune systems, new-born babies, the elderly, sick people, and patients who spend an extended time in a healthcare facility,” says Dr Moodley Naidoo.

Heeding the ‘10 Commandments of AMR’ - a global imperative

The AMR Review sets out 10 key focus areas for global action which O’Neill calls ‘The 10 Commandments of AMR’:

1. We need a global public awareness campaign. 
2. We must improve sanitation. Polluted environments fuel illness and overuse of antibiotics.
3. We must reduce unnecessary use of antimicrobials in agriculture and their dissemination into the environments. For 10 years the European Union (EU) has banned use of antibiotics for growth promotion in animals. In October 2018, the EU introduced a law that will come into effect in 2022, to ban last-in-line antibiotics (intended for humans) in animals. 
4. We must improve global surveillance of drug resistance and antimicrobial consumption.
5. We need rapid, digitally-enabled diagnostics to reduce unnecessary use of antimicrobials.
6. We must promote the development and use of vaccines and alternatives to antimicrobials.
7. We must improve the number, pay and recognition of people working on infectious disease.
8. We must increase the supply of new antimicrobials effective against drug‑resistant bugs.
9. We need a global innovation fund for the supply of new, effective antimicrobials.
10. We need better incentives to promote investment in new drugs and improve existing ones.

What will it cost the world to overcome AMR?

Global leaders in healthcare have been emphatic in their support of the AMR Review, which estimates that interventions require $42-billion to implement. Lord O’Neill adds:  “That $42-billion, over 10 years, is less than one quarter of a tenth of a percent (0.025%) of global GDP. Yet, if we do nothing about it, the world would lose approximately $100-trillion of accumulated GDP over the next 35 years – and 10 million people each year, by 2050.”

Global collaboration and billions in Funding Key to tackle AMR

At the Discovery Leadership Summit, Lord O’Neill added that collaboration is essential: “The overuse of Colistin on animals in China has resulted in this drug recently being detected in Denmark – a country that has led global efforts to stop the use of antimicrobials in animals. International cooperation is therefore critical to overcoming this challenge.”

He pleaded: “Make sure South Africa continues to keep AMR on the BRICS agenda, as well as when using its own voice in the G20. The actions that we’ve set out today are ambitious in their scope – but this is a problem which is well within our grasp to solve if we take action now. I call on the governments of the G7, G20 and the UN to take real action in 2016 on the 10 proposals made by my review, to avoid the terrible human and economic costs of resistance that the world would otherwise face.’

The growing list of resistant pathogens spans multiple regions

MDR Tuberculosis is the most common and lethal airborne AMR disease worldwide today, responsible for 250 000 deaths each year. Only two new antibiotics for treatment of MDR-TB have reached the market in over 70 years. R&D investment in TB – seriously underfunded - is at its lowest level since 2008.

The WHO’s critical priority super-bugs include Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacteriaceae. Resistance in Klebsiella pneumoniae – a common intestinal bacteria – to a last resort treatment (carbapenem antibiotics) has spread to all regions of the world. Resistance in E. coli to one of the most widely used medicines for the treatment of urinary tract infections - fluoroquinolone antibiotics - is very widespread. People with MRSA (methicillin-resistant Staphylococcus aureus) are estimated to be 64% more likely to die than people with a non-resistant form of the infection. Colistin is the last resort treatment for life-threatening infections caused by Enterobacteriaceae, which are resistant to carbapenems. Resistance to colistin (used as a growth promoter for livestock) has recently been detected in several regions, making infections caused by such bacteria untreatable. Treatment failure to the last resort of medicine for gonorrhoea (third generation cephalosporin antibiotics) has been confirmed in at least 10 countries (Australia, Austria, Canada, France, Japan, Norway, Slovenia, South Africa, Sweden and the United Kingdom of Great Britain and Northern Ireland).

What can health professionals do to reduce the impact of AMR?

To prevent and control the spread of antibiotic resistance, health professionals can:

• Prevent infections by ensuring your hands, instruments, and environment are clean.
• Only prescribe and dispense antibiotics when they are needed, according to current guidelines.
• Report antibiotic-resistant infections to surveillance teams.
• Talk to your patients about how to take antibiotics correctly, antibiotic resistance and the dangers of misuse.
• Talk to your patients about preventing infections (for example, vaccination, hand washing, safer sex, and covering nose and mouth when sneezing).