The New Straits Times, February 18, 2001
By Prof. Dzulkifli Abdul Razak
THE New England Journal of Medicine (NEJM), in a recently released study, reiterated the concern that antibiotics are losing their effectiveness due to overuse. The research warned tha the risk of developing an antibiotic-resistant infection rose by about one-third from 1995 to 1998 _ the study period.
In fact, one of the top worries last year was the increasing antibiotic resistance said to have reached "monumental levels around the globe" (Poison Control, July 9, 2000).
The World Health Organisation (WHO) estimates that 10 million people are dying of infectious diseases related to antibiotic resistance. What is more shameful is that many of the diseases are curable, including acute respiratory infections, diarrhoea, malaria and tuberculosis (TB). The list is growing according to WHO.
Many cases, such as acute respiratory infections and diarrhoea, can be treated without the use of antibiotics.
On the contrary, in cases of TB, antibiotics are very important for treatment. In fact once confirmed it is the regimen of choice. The usual treatment mostly involved anti-TB drugs such as isoniazid, rifampicin, pyrazinamide, streptomycin and ethambutol.
What is more worrying is that TB is on the rise as well. This concern has been expressed by WHO as far back as 1993 when it declared TB as a global emergency. Currently nearly one per cent of the world's population is newly infected with TB every year.
Southeast Asia alone accounts for almost 49 per cent of the global TB burden. There are three million cases, with 700,000 others facing death annually. The global figure is estimated at two billion.
At home, while the situation is still under control, the country is bordering many others with a high TB burden like Indonesia, Thailand, the Philippines Bangladesh and India. Many of our foreign workers come from these countries.
A person needs only to inhale a small amount of the microbes in the air to be infected. Sources from the Ministry of Health indicate that the number of TB cases in Malaysia has risen from about 11,000 in 1990 to about 15,000 in 1999.
The situation with TB may well be just the tip of the iceberg. This is because TB is compounded by the AIDS epidemic with even more severe consequences because when the immune system becomes deficient and weakened, the TB microbes become more dominant. Under ordinary conditions, those who are infected with the microbes may not necessarily be sick since the immune system is able to keep the microbes under check.
The use of antibiotics must be strictly regulated and monitored. After all, above half of the estimated 160 million antibiotic prescriptions written each year in the US (for some 11.3 million kilogrammes of the medicines) were deemed as unnecessary, according to an editorial in the journal.
The head of the infection control programme at the University of Virginia Medical Centre in Charlottesville was cited as saying that "hospitals are more dangerous than ever", that is one is more easily infected by resistant strains in the hospitals.
Patients who remain in the hospitals are often seriously ill, with weakened immune systems. They are then at a higher risk to the microbes and consequently the infection.
Hospitals therefore must be not only be made to effectively implement infection control policy and procedures but also to inform the public as to their policy and their performance periodically. In some cases, many are actually defaulting on infection control programmes in order to save money.
A form of rating scheme for the various health outlets with respect to their infection rates would be most appropriate and timely. A periodic certification system would be imperative if the spread of antibiotic-resistance, more so the multidrug version, is to be checked with participation of the public.
To quote a view from a University of Virginia, Michael Osterholm, "A lot of hospitals and long-term care facilities are putting their heads in the sand regarding infection control."
Like the naming of "baby-friendly hospitals", designating those deserving as drug-resistant-free hospitals can markedly increase the level of public awareness about the state of affairs while keeping hospitals on their toes.
Of course, if all attempts fail, the other option is as suggested by British Health Minister of granting powers of "naming and shaming" hospitals that have above-average levels of infection. This may be more apt for those which are insistent on putting greed before health care.
