Antimicrobial resistance: how can an intersectoral approach between society and healthcare professionals be developed and applied?

This article was exclusively written for The European Sting by Ms Fernanda Melo Gadelha Sarmento, a student from the fourth period of Medicine of the State University of Rio Grande do Norte-UERN. She is affiliated to the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong strictly to the writer and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.

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In the last century, the development of several drugs able to directly fight infections revolutionized the Healthcare Area, specially Medicine and Pharmacology. In the other hand, the dissemination and indiscriminate use of this drugs opened a window to a quick growth of microbial resistance mechanisms that the humanity can’t control yet. Therefore, this phenomenon presents itself as one of the majors challenges imposed by the nature nowadays. The genetic mutation capacity of micro-organisms is a known and considered fact by the science since the antibiotical drugs breakthrough. However, the resistance that we fight today has reached a “boost” from a tripod of inconsequent human actions: indiscriminate prescription of broad-spectrum antibiotics, patients that self-medicate themselves or don’t respect the medicine’s posology and the lack of control at the commercialization of these drugs, especially in under-developed countries; consequently, it turned to be a global public health problem. A strategy that is well accepted is the commercialization of some medications only by prescription, but it is not enough, since superbacteria already cause 23000 deaths per year in Brazil, besides a huge burden on the public health budget. Whereas pharmaceutical industries take 10 years to develop a medicine, some bacteria like Escherichia coli can divide itself every 20 minutes when conditions are favorable such as the right temperature and nutrients are available. This means that in just 7 hours one bacterium can generate 2,097,152 bacteria. That said, the most reasonable solution seems to come from the agents that sustain the mentioned tripod: physicians, patients and health surveillance institutions, in a cooperative effort. First of all, as a large fraction of the blame is in doctors’ hands, that many times prescribe antibiotics on an indiscriminate way, the first part of the solution would be the use of microbiological tests at the consult to identify the etiologic agent causing the patient’s disease. These tests come as kits and can be made at the doctor’s office; they can identify the most frequent bacteria such as E. coli and Salmonella. The costs are a downside, but it would allow the healthcare system to have accurate diagnoses, avoiding prescriptions of broad-spectrum antibiotics and even prescriptions of antibiotics in non-bacterial infections, that frequently occurs. However, this isn’t enough. This approach’s focus places at the patients, so the general population can have knowledge of what is being fought. Therefore, the second part meets with a coordinated action of pharmacists and patients, taking place at the pharmacists informing and raising social awareness about respecting the medication’s posology (doses and treatment duration) and the risks of resistance, avoiding self-medication and treatment disruption. The last vertex of the mentioned tripod is the adequate monitoring by national institutes (FDA in US, ANVISA in Brazil etc) of drugs commercialization, especially in remote locations of the countries, ensuring the correct sell of antibiotics, with right prescription retaining. In light of the above, microbial resistance can only be controlled with an intersectoral approach, involving not just the physician, but different areas, as a public health common problem worldwide. References LIVERMORE, DAVID M. Bacterial Resistance: Origins, Epidemiology and Impact. Clinical Infectious Diseases, Volume 36, Issue Supplement_1, January 2003, Pages S11–S23, https://doi.org/10.1086/344654 Microbiology Online: Acess on 19 Nov. 2019. Available at https://microbiologyonline.org/about-microbiology/introducing-microbes/bacteria SILVEIRA, Gustavo Pozza et al . Estratégias utilizadas no combate a resistência bacteriana. Quím. Nova,  São Paulo ,  v. 29, n. 4, p. 844-855,  July  2006 .   Available from <http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0100-40422006000400037&lng=en&nrm=iso&gt;. access on  20  Nov.  2019.  http://dx.doi.org/10.1590/S0100-40422006000400037. About the author Fernanda Melo Gadelha Sarmento is a student from the fourth period of Medicine of the State University of Rio Grande do Norte-UERN. Member of the Social and Cultural Committee of the Ernani Rosado Academic Center of Medicine and IFMSA Brasil-UERN Trainee. She believes that information generation and dissemination above from science community and aiming towards the population is the key to improve the society, Healthcare Area included.