ANTIMICROBIAL RESISTANCE : ITS MEDICAL AND LEGAL VANTAGE POINT By OMOTOSHO OLUWADAMILOLA MARVELLOUS AND OGUNMOLA HANNAH ILERIAYO
ABSTRACT
A research undergone by WHO ,
declared that AMR is one of the top TEN global public health threats
facing humanity. It threatens the effective prevention and treatment of an
ever-increasing range of infections caused by bacteria, parasites, viruses and
fungi .
Antimicrobials - including antibiotics,
antivirals, antifungals and antiparasitics - are medicines used to prevent and
treat infections in humans, animals and plants. Microorganisms that develop
antimicrobial resistance are sometimes referred to as “superbugs”. It is the
aim of this article to sensitize the masses on the causes ,effect and legal
advise given to this subject matter.
INTRODUCTION
Antimicrobial resistance (AMR) is a
global health and development threat. It requires urgent multisectoral action
in order to achieve the Sustainable Development Goals (SDGs). It has emerged as
one of the principal public health problems of the 21st century that threatens
the effective prevention and treatment of an ever-increasing range of
infections caused by bacteria, parasites, viruses and fungi no longer
susceptible to the common medicines used to treat them.
AMR occurs naturally over time, usually
through genetic changes. Antimicrobial resistant organisms are found in people,
animals, food, plants and the environment (in water, soil and air). They can
spread from person to person or between people and animals, including from food
of animal origin. The main drivers of antimicrobial resistance include the
misuse and overuse of antimicrobials; lack of access to clean water, sanitation
and hygiene (WASH) for both humans and animals; poor infection and disease
prevention and control in health-care facilities and farms; poor
access to quality, affordable medicines, vaccines and diagnostics; lack of
awareness and knowledge; and lack of enforcement of legislation.
However, it is said that the problem of AMR
is especially urgent regarding antibiotic resistance in bacteria. Over several
decades, to varying degrees, bacteria causing common or severe infections have
developed resistance to each new antibiotic coming to market. Faced with this
reality, the need for action to avert a developing global crisis in health care
is imperative. It must be noted that ANTIMICROBIAL RESISTANCE is same with (=)
ANTIMICROBIAL DRUG RESISTANCE.
MEDICAL
SCRUTINY
ANTIMICROBIAL resistance is one
of the three major threats to human health. It is a well-known fact that
antimicrobials save lives. However, there has been an acceleration of
resistance when the microbes are pressured to adapt. All classes of microbes
can develop resistance. Fungi evolve antifungal resistance. Viruses evolve
antiviral resistance. Protozoa evolve antiprotozoal resistance, and bacteria
evolve antibiotic resistance. To be precise, antimicrobial resistance doesn't
mean the body is resistant to antimicrobials, but that the microbe causing the
infection is resistant to the treatment.
Basically, the misuse and overuse of
drugs are the major drivers in the development of drug-resistant pathogens.
Ranging from inappropriate choices to inadequate dosing and poor adherence to
treatment guidelines, antibiotic resistance keeps on increasing, all with
gradual changes in the normal microbiota of the body,
First of all, there is a need to
understand how antimicrobial drugs act normally. One of which is selective
toxicity. An ideal antimicrobial agent exhibits selective toxicity, which means
that the drug is harmful to a pathogen without being harmful to the
host.Inhibition of cell membrane synthesis and function is also a means through
which antimicrobial drugs act. The cytoplasm of all microbes are bounded by the
cytoplasmic membrane, which serves as a selective barrier thus controlling the
internal composition of their cell. If the functional integrity of the
cytoplasmic membrane is disrupted, macromolecules and ions escape from the
cell, and cell damage or death of microbe ensues.
In addition, by inhibition of
protein or nucleic acid synthesis, a microbe can be destroyed. Since the
chemical composition and functional specificities of a microbial cell is
sufficiently different from a mammalian cell, this explains why antimicrobial
drugs can inhibit protein synthesis in bacterial ribosomes without having a
major effect on mammalian ribosomes.
One would
expect that with this, no form of resistance will ensue. Still, the reverse is
the case.
Curious as
to how this occurs?
Microbials develop defense strategies
called resistant mechanisms. When already hard-to-treat germs have the right
combination of resistance mechanisms, it can make antimicrobials ineffective,
resulting in untreatable infections. Alarmingly, resistant microbes can share
their resistance mechanisms with other germs that have not been exposed to
antibiotics.
Besides, microorganisms can change their
permeability to the drug. This is by developing an altered metabolic pathway
that bypasses the normal reaction inhibited by the drug. In some cases, an
altered enzyme that can still perform its metabolic function can be developed,
which is much less affected by the drug.
Moreover, some microorganisms can
produce enzymes that destroy an active drug. Examples: Staphylococci resistant
to penicillin G produce a β-lactamase that destroys the drug. Also, Klebsiella pneumoniae bacteria produce
enzymes called carbapenemases, which break down carbapenem drugs and most other
beta-lactam drugs.
By the way, changing the targets for the
drug can occur. Using bacteria as a case study, antibiotic drugs are designed
to single out and destroy specific parts of a bacterium. The antibiotic’s
target can be changed and then the drug can no longer find and do its job.
Germs change or destroy the antibiotics with enzymes, and proteins that break
down the drug, getting rid of the antibiotic.
Antimicrobials can as well be restricted
access by changing entryways or reducing the number of entryways to a microbial
cell.
"For
every problem, there is always a root cause", so they say. People's influence is a
significant contributing factor in the occurrence of antimicrobial resistance.
If a person does not complete a course of antimicrobial drugs, some microbes
may survive and develop resistance to the drug. Resistance can also develop if
people use drugs for conditions that they cannot treat. Such can be seen in
cases where people sometimes take an antibiotic for a viral infection.
Furthermore, antimicrobial resistance can
be conferred on a specie of organism by another specie. Such is the case of
animals fed with antibiotics which cross contaminates the human world when we
feed on their meat. Microorganisms resistant to a certain drug may also be
resistant to other drugs that share a mechanism of action. Such relationships
exist mainly between agents that are closely related chemically. Or that have a
similar mode of binding or action e.g, macrolides and lincomycins.
Moving further, the impact of antibiotic
resistance in terms of mortality and the public health cost is quite difficult
to estimate. Modern medicine depends on the availability of effective
antibiotic drugs such as chemotherapy for cancer treatment, organ
transplantation, hip replacement surgery, intensive care for pre-term newborns,
and many more. In fact, infections caused by multidrug-resistant bacterial
strains are among the main factors influencing morbidity and mortality in
patients undergoing these procedures. More alarmingly, the infections they
cause are harder to treat than those caused by non-resistant bacteria.Increased
resistance leads to elevated costs associated with more expensive antibiotics,
as well as the need for more specialised equipment, longer hospital stays, and
isolation procedures for the patients. When infections become resistant to
first-line antimicrobials, treatment has to be switched to second or third-line
drugs, which are nearly always more expensive.
Why should
there be a sound of alarm? It's because, without effective antimicrobials, the success of modern
medicine will be at increased risk.
Like David
Cameron, former UK Prime Minister once said, "If we fail to act, we are
looking at an almost unthinkable scenario where antibiotics no longer work and
we are cast back into the dark ages of medicine"
An
alternative treatment gotten by combinations of different medications, known as
multiple-drug therapy can be used to combat resistant microbes.
Research has
shown that monoclonal antibodies can help in combating the effects of the
toxins that the microbes produce. The influence of vaccines too should not be
underestimated, especially since they can go a long way in preventing the
occurrence of an infection.
LEGAL
SCRUTINY
However, the universal ambit of
antimicrobial resistance is a pointer to the fact that an integrated strategy operating at both
the national and international legal levels is needed. Such an integrated
strategy faces political and legal challenges.
International legal harmonization of principles for prudent
antimicrobial drug use will have to include monitoring and enforcement, as well
as financial, technical, and legal assistance by industrialized countries to
developing countries.
The
international legal strategy needed will be difficult to create. WHO’s limited
powers to adopt regulation do not seem to extend to creating regulations
regarding the use of drugs. WHO has not, for example, proposed revising the
International Health Regulations to rationalize the use of antimicrobial drugs.
WHO has authority to adopt a convention on the use of antimicrobial drugs but
it has not done so . Lessons from international environmental efforts suggest
that international law must play a major role in setting international
standards for implementation domestically and creating the political,
technical, and financial conditions necessary to integrate international and
national law.
Obviously, realistic national strategies
confront legal and political hurdles. In the United States, state legislatures
probably have the power to regulate how physicians prescribe antimicrobial
drugs, but any attempt to legislate more rational use of drugs might evoke
negative reactions from physicians and their medical associations, who might
oppose the government’s efforts to interfere with their professional judgment .
If formal legislative regulation would not prove feasible, an alternative would
be self-regulation by the medical and veterinary professions through practice
guidelines, for example A peer review
process to monitor antimicrobial drug use has also been recommended . Managed
care organizations may be included in the effort to control misuse of
antimicrobial drugs, given their power and economic incentives to curb such
misuse by physicians.
Strategies to
address antimicrobial resistance as a public health and legal challenge must
consider three levels of interdependence: among the antimicrobial drug
surveillance, use, and R&D components of the public health strategy; among
the levels of law—national and international; and between the public health and
legal aspects of dealing with antimicrobial resistance.
Each element
of the public health strategy against antimicrobial resistance affects and
depends on the other elements. Because antimicrobial resistance is a global
problem, national legal reforms taken in one or a few countries would suffer if
other countries did not take similar actions. For example, since drug resistant
pathogens travel easily in today’s world, national legal reforms to rationalize
antimicrobial use in a few countries might be subverted if such misuse is not
curtailed in many other countries.
A blueprint to address antimicrobial
resistance as a public health and legal challenge must consider three levels of
interdependence: among the antimicrobial drug surveillance, use, and R&D
components of the public health strategy; among the levels of law—national and
international; and between the public health and legal aspects of dealing with
antimicrobial resistance. Each element of the public health strategy
against antimicrobial resistance affects and depends on the other elements.
More rational use of antimicrobial drugs and increased R&D depend on
accurate surveillance.
Confronting antimicrobial resistance
requires not only a scientific and public health strategy but also a legal
strategy. Including law in the developing discourse will broaden and strengthen
the strategy for combating antimicrobial resistance.
CONCLUSION
It must be well noted and put into our
conciousness that creation of new
international legal duties would likewise be undermined if such duties were not
translated into national law. Thus, any legal strategy against antimicrobial
resistance must be pursued at both the national and international levels. An
effective change is up to us. A wise man once said that the root cause of all
the problems we have in the world today is ignorance. It is crystal clear that
new antimicrobials are needed. However, if people do not change the way they
use drugs, the new ones will suffer the same fate as the old ones. Here comes
the need for proper sensitization of people on the appropriate use of
antimicrobial drugs. Without any iota of doubt, the risk of antimicrobial
resistance will be drastically reduced.
REFERENCE
[1] WHO 'Antimicrobial
resistance' (World health organization, 17, November,
2021) <https//:www. int/who. com> accessed 11 May 2022
[2] PFidler David, 'Legal Issues
Associated with Antimicrobial Drug Resistance' (Indiana University School
of Law, Bloomington, Indiana, USA, 2021) <http://jstor.
com> accessed 11 May 2022
[3] https://www.pdfdrive.com/jawetz-melnick-adelbergs-medical-microbiology-28th-edition-e200782660.html
[4] https://www.medicalnewstoday.com/articles/283963A
[6] https://www.cdc.gov/drugresistance/about/how-resistance-happens.html
[7] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4768623/
ABOUT
US
@
OMOTOSHO DAMILOLA MARVELLOUS
A noble student of the prestigious Faculty of law
,Adekunle Ajasin University, Akungba Akoko in Ondo state. He is a Fervid
article writer on Law encompassing Scientific fields, for instance SPACE LAW,
ENVIRONMENTAL LAW, ELECTRICITY LAW, HEALTH LAW, MEDICAL LAW,ENERGY LAW AND SO
ON He can be reached via omotoshomarvellous57@gmail.com
@ OGUNMOLA HANNAH ILERIAYO
She is a writer who is skilled at conveying not just
messages, but emotions through words. She has always loved writing and she .
fits her medical knowledge into her articles. You can be rest assured of
fascinating and insightful articles, as long as you watch out for her
contents.All in all, Hannah’s write-ups are a perfect description of engaging,
lucid and enlightening. ogunmola.hannah01@gmail.com
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