Vet on call: Trouble with misuse of those antibiotics

Clara Chebet feeds her dairy cattle in her farm in Elburgon, Nakuru County. Changing conditions in the relationships between man and livestock dictate that humans and animals will increasingly share more disease-causing micro-organisms. PHOTO | JOHN NJOROGE | NMG

What you need to know:

  • Antibiotics are crucial to the health and survival of man and domestic animals.
  • Save for vegetarians, all of us relish meat, milk and eggs from animals where antibiotics have been used to treat diseases.
  • Antimicrobials, on the other hand, are drugs used in the treatment of diseases caused by any type of micro-organism or used to kill micro-organisms to prevent diseases.
  • Salmonella, Escherichia coli and Streptococcus bacteria are particularly common micro-organisms in both animals and humans.

Tomorrow marks the end of the World Antibiotic Awareness Week (WAAW) 2018, which has been running from November 12 and is coordinated by the World Health Organisation globally, while the ministries of Health and Livestock in each country plan national activities.

So, what is the big deal about the week since antibiotics are in common usage?

Antibiotics are crucial to the health and survival of man and domestic animals. Changing circumstances in the relationship between man and livestock dictate that humans and animals will increasingly share more disease-causing micro-organisms.

Imagine how many people spend their time working in farm animal houses, transporting and slaughtering animals and processing meat and meat products. All these people are exposed to micro-organisms from animals and the reverse is true for the animals.

After work, the workers share close environments with others who are not directly exposed to the animals.

Save for vegetarians, all of us relish meat, milk and eggs from animals where antibiotics have been used to treat diseases.

The big question is, are we being exposed to antibiotic resistant micro-organisms from animals and varying quantities of antibiotics in foods of animal origin?

The other question is whether humans are also exposing animals to antibiotic resistant micro-organisms. Unfortunately, the answer to both questions is yes.

In November 2015, WHO launched the first WAAW. The aim is to increase global awareness on antibiotic resistance and to encourage best practice among the public, human and animal health workers and policymakers to avoid further emergence and spread of antibiotic resistance.

Let me first explain the two terms, antibiotic and antimicrobial resistance. Antibiotics include drugs such as penicillin and tetracycline.

Antimicrobials, on the other hand, are drugs used in the treatment of diseases caused by any type of micro-organism or used to kill micro-organisms to prevent diseases.

These include synthetic drugs such as sulphonamides and even common antiseptics such as Dettol. The WHO interventions to prevent antibiotic resistance have been expanded to include the prevention of antimicrobial resistance (AMR).

ANTIBIOTIC RESISTANCE

We should all be concerned about the development of AMR rather than only antibiotic resistance. The latter occurs when bacteria are able to survive despite treatment with antibiotics that killed them before.

On the other hand, antimicrobial resistance occurs when a micro-organism that was killed by a specific drug before is able to survive treatment with the same drug.

One of the most prominent AMR cases globally is the development of multi-drug resistant tuberculosis (MDR TB) that results in lengthy expensive treatment of patients and increased deaths.

In Kenya, AMR has been documented in salmonella, Escherichia coli, Cholera, Campylobacter and Streptococcus bacteria.

Salmonella, Escherichia coli and Streptococcus bacteria are particularly common micro-organisms in both animals and humans.

The first two are mainly found in the gut and are heavily shed in faeces. This provides an easy way of infection of animals and humans through contaminated food and water.

AMR gravely threatens the prevention and treatment of an ever-growing range of infections. Bacteria with AMR cause reduced effectiveness of treatment, increased infections and deaths, longer duration of patients’ hospital admission and requirement for more intense care.

In addition, the cost of healthcare is increased and there is spread of multi-drug resistant bacteria.

In my practice over the years, I have come across requests from farmers that would contribute to development of AMR.

I have even lost clients because of rejecting such requests and the farmers disagree with the options I advise.

Two weeks ago, a farmer called me from Murang’a asking for an antibiotic prescription for her chickens which had diarrhoea and some were also coughing.

She said she had given antibiotics to the chicken before and the problem appeared to have resolved but had now recurred.

She said she called me to be sure she had the correct antibiotic. This is called self-medication and is one of the main causes of AMR both in animals and humans.

ALWAYS SOLD WITH DOCTORS' PRESCRIPTION

The culprits are the farmer or the patient and the chemist attendant who supplies the drugs. Antibiotics should always be sold with a doctor’s prescription whether for use in humans or animals.

I explained to her the issues of AMR and its threat to human health. She was grateful for the phone tutorial. She later confirmed her chickens had been treated by a parapet and a withdrawal period of 10 days for the eggs was advised.

“Doctor, I will incur some losses but I will persevere to protect other people,” she concluded. I congratulated her for her best practice decision.

AMR occurs because of five main reasons. The first is health providers doing treatment based on poor or tentative diagnosis where laboratory testing is not used to determine the specific infection.

Second is inappropriate dispensing of antimicrobials, which comprises of too much use, too little use, use for wrong reasons or inappropriate conditions and the use of antibiotics for unintended purposes. This is simply termed as overuse, underuse, misuse and abuse of antimicrobials.

The third reason is self-medication where farmers buy medicines for their animals and human patients buy for themselves without a prescription.

Fourth is the failure by farmers, patients and healthcare professionals to comply with treatment guidelines at their respective levels of responsibility.

The fifth reason is inappropriate storage of medicines by both healthcare professionals and users of medicines. Lastly, it is the failure of proper usage of infection prevention in both animals and humans. If we vaccinated against all diseases prevented by vaccines, then we would have very few diseases affecting people and humans.

Nutrition helps in improving body immunity in humans and animals and good management such as hygiene, clean environment and shelter deny micro-organisms the opportunities to infect.

AMR develops when bacteria are repeatedly exposed to drug concentrations below the killing dose. Some of the bacteria learn how to breakdown the drugs and render them ineffective.

Kindly, do not give bacteria the chance to triumph over us and our animals.