Collaboration key in fighting deadly drug resistance

  • A MORE “one health” approach to combating antimicrobial resistance should help safeguard the vital drugs’ future for humans and animals.

    A report from the National Academies of Sciences, Engineering, and Medicine, the collective scientific national academy of the US, has made a number of recommendations on strategies to combat the growing threat of resistance.

    Although antimicrobial resistance is most apparent in human medicine, the report says policymakers should consider the interconnectedness of human, animal, and environmental health.

    Guy Palmer, regents professor at Washington State University and chair of the committee that wrote the report, told H&H measuring the impact reducing resistance in one population, such as livestock, would have on another is important in making related policies.

    The wider environment is also key – antibiotic resistance has been recorded in wildebeest, which must be owing to their sharing an environment with animals who have been treated. Studies on crowded slums have also shown resistance spreads between households.

    “These two examples show the importance of shared environments, and that’s part of the solution,” he said. “That’s why the one health approach is so critical.”

    Dr Palmer added that in these cases, just using antibiotics less is not enough; vaccination and preventing infection is also key, to reduce the need for the drugs, and the academies committee wants to look more into the effects of vaccination on resistance.

    He said that one main outcome of widespread resistance will be that fairly routine procedures, such as knee replacements or colic surgery, will become untenable.

    “All these procedures, which we’ve come almost to take for granted, depend on having effective infection control,” he said. “If I needed a knee replacement but knew there was a 10% chance I’d get an untreatable infection, I wouldn’t go in, I’d take a sore leg over no leg.

    “It’s the same in horses; it’s very difficult to have absolute infection control in colic or orthopaedic surgery, and the risk is controlled by having effective antibiotics. Without them, it would be untenable.”

    Dr Palmer stressed the need for good management and biosecurity in keeping horses to reduce the need for antibiotics, with which Dave Rendle, chair of the British Equine Veterinary Association health and medicines committee, agrees.

    Mr Rendle told H&H: “Horse owners need to play their part in reducing the use of antimicrobials.  It is in their interest, as with resistance will come higher treatment costs and poorer outcomes. Horse owners shouldn’t ask for antimicrobials ‘just in case’ and should respect the vet if he or she decides antimicrobials aren’t necessary. Prevention of infection is always better than cure and through good management the risk of bacterial infections is reduced; for example, vaccination, isolation of new horses and regular washing of hands, clothing and equipment will reduce spread of infection, prompt cleaning and disinfection will promote wound healing.

    “Everyone – doctors, vets, farmers, horse owners – has to take collective responsibility for preventing antimicrobial resistance.”

    The World Health Organization (WHO) told H&H resistance means current antibiotics are less effective than before.

    “Antibiotics have been abused in human and animal health and in food production,” a spokesman said. “Resistance that develops in one species can easily spread to others, including humans; spread through water and in the environment compounds the issue.

    “If we are to preserve these drugs for future generations, there needs to be action across sectors, a one health response, to prevent and manage infection better.”

    The WHO works with bodies including the World Organisation for Animal Health and the UN Environment Programme to support action across sectors and has published guidance setting out the case for a one health approach.

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