AMR – the silent pandemic

Caution needed: According to Prof Sharifa Ezat, there is an increase in AMR in the country due to the overuse and misuse of antibiotics in various fields.

Many not aware of effect from misuse of antibiotics

PETALING JAYA: With Covid-19 still lingering, many may not realise that there is another “silent pandemic” known as antimicrobial resistance (AMR).

Citing the forecast of the 2014 UK report known as Review on Antimicrobial Resistance, Tengku Dr Zetty Maztura Tengku Jamaluddin, who is Infection Control Unit head of Department of Medical Microbiology at Sultan Abdul Aziz Shah Hospital UPM, said AMR will affect 4.75 million individuals in Asia.

AMR is a global health issue that challenges the efficacy of existing treatments, she said.

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“AMR refers to the ability of micro-organisms such as bacteria, viruses, fungi and parasites to adapt and become resistant to the drugs or antimicrobial agents that were initially effective in treating them,” said Tengku Dr Zetty, who is also a medical lecturer at Universiti Putra Malaysia’s Faculty of Medicine and Health Sciences.

She added that AMR limits therapy, resulting in longer hospital stay and increases mortality rates.

“Hence, combined with this, higher costs are needed to treat AMR infections as more expensive drugs are required,” she added.

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In the late 1990s, the National Surveillance Antibiotic Resistance (NSAR) was initiated with several other measures implemented, including the Malaysia Action Plan for Antimicrobial Resistance (MyAP-AMR) 2017-2021.

In December, an AMR symposium known as “Preventing AMR”, featuring eight prominent health experts including from Singapore, Japan and Australia, is slated to be held.

Prof Dr Sharifa Ezat Wan Puteh of Universiti Kebangsaan Malaysia said there is an increase in AMR in the country due to the overuse and misuse of antibiotics in various fields.

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“AMR occurs due to increases in antibiotic misuse in humans, livestock and agriculture, inappropriate use of under-dosing and over-prescribing, and misuse of antibiotics including for viral infections where they are not effective.”

She described AMR as a silent pandemic due to most cases going undetected, especially in outpatient clinics.

“It can be present in many ways; for example, resistance to tuberculosis drugs as many drugs may not work as usual,” she said.

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She said AMR patients are more prone to complications and there are fewer new antibiotics being developed to deal with them.

Professor Sadequr Rahman from Monash University Malaysia’s School of Science, who was involved in studies related to AMR, said the Asean region is regarded as a problem area when it comes to the prevalence of AMR bacteria.

“The situation in Malaysia as a whole is similar to other countries in the region, although Thailand is generally worse,” he said.

He said the university’s public health observatory, South-East Asia Community Observatory (SEACO), that is based in Segamat, Johor, had conducted a study to investigate the types of bacteria that healthy people carry.

“Our findings about one in five healthy people carried bacteria in their guts that were resistant to a common antibiotic are not particularly surprising. It is in line with studies in other countries.

“These antibiotic-resistant bacteria would not be a problem unless they managed to get into our bloodstream to cause infections. Any bacteria getting into our bloodstream to cause infections is a problem; if they are resistant to a common antibiotic, they are harder to kill.”

He said although one of the five test subjects carried bacteria that were resistant to a common antibiotic, most of the bacteria they carried were not antibiotic resistant.

Prof Sadequr said although the government had imposed strict guidelines on prescription antibiotics for the past decade, the poultry and aquaculture industries are the “greatest” users of antibiotics.

He said they use antibiotics to try and ensure their products do not get bacterial infections, which is an abuse of antibiotics.