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The Global Emergence of Antibiotic Resistance:

Subash

Rapid Emergence and Spread of Antimicrobial Resistance: 

The persistent overuse and misuse of antibiotics in human health have encouraged the emergence and spread of antibiotic resistance globally, which occurs when microbes, such as bacteria, become resistant to the drugs used to treat them.

The sexually transmitted infections (STIs) remains a significant global public health concern and this requires immediate international attention and resources because the global burden of infection is increasing every day. The looming global public health crisis of antimicrobial-resistant is due to lack of (or suboptimal) diagnosis, over-the-counter access to antimicrobials without prescription, and limited access to optimal antimicrobial treatment.  These factors create the perfect conditions for rapid emergence and spread of antimicrobial resistance, which is a major problem globally, but the AMR situation varies in different parts of the world and changes over time.

The global health body said every year, an estimated 35.2 million people were infected by the disease in the WHO’s Western Pacific Region and 11.4 million in the South-East Asian Region, which includes India. Public health control of none viral bacterial and protozoan STIs are dependent on the delivery of effective therapy and so will be compromised by the emergence of resistance. Emerging resistance in all bacterial STIs and the particular problem of resistant Gonorroheae will present a challenge to maintain antimicrobial therapy at the forefront of public health control. Emerging resistance has been documented in all the bacterial STIs, but is considered rare and unconfirmed in Chlamydia trachomatis (CT) whereas is of global concern in Neisseria gonorrhoeae (NG). As an example antibiotics used for treatment of CT infections, Azithromycin resistance has now been recognized in Mycoplasma genitalium (MG), Treponema pallidum (TP) and NG, questioning its widespread use for chlamydial infection and threatening its future use. Same as in case of NG, rapidly increasing levels of decreased susceptibility to the extended-spectrum cephalosporins in NG and emerging treatment failures to both cefixime and ceftriaxone, without an obvious alternative agent, are of considerable concern. Implications for treatment include choice and timing of any change in therapy, reintroduction of test of cure and definition of treatment failure in an era of molecular testing.

During treatments of the specific infections using combination or broad spectrum antibiotics is good approach but; when left undiagnosed and untreated, these STIs can result in serious complications and long-term health problems for women, such as pelvic inflammatory disease, ectopic pregnancy, and miscarriage, and untreated infections can cause infertility in both men and women. These infections are major public health problems worldwide, affecting millions of peoples’ quality of life, causing serious illness and sometimes death. The new WHO guidelines reinforce the need to treat these STIs with the right antibiotic, at the right dose, and the right time to reduce their spread and improve sexual and reproductive health.

The WHO said antibiotic resistance has appeared and expanded with every release of a new antibiotic class for managing Gonorrhea. According to the guidance update, countries should track antibiotic resistance patterns in the strains that are circulating in their populations. The WHO estimates that 131 million people are infected with CT each year, making it the most common bacterial STI. People infected with CT are frequently co-infected with gonorrhea. Treatment failures have been reported for tetracycline and macrolides, according to the WHO. The new guidance provides updates for first- and second-line treatment of the disease.

The transmission, screening and treatment of infectious diseases are a dynamic process determined by various factors originating from disease pathogenesis and human populations. Most of the cases treatment of STIs underwent via Gynecologist and Dermatologist rather in STI/RTI clinics because of social stigmas. The load of patients in Obs & Gynecologist and dermatology is too high, and time given to patients is very little to counsel the patients, which is also important to understand; the pattern of discharge, type of discharge, pattern of fever with pain, individual hygiene and sexual behavior complex to understand including clinical sequel, which play key role in subjective judgments based treatment but it is miss out in practices.

The emergence of antibiotic resistance is a natural biological phenomenon that occurs as a reaction to the use of antibiotics. The emergences of resistance to antimicrobials happened because of the ongoing war between the disease and its effective treatment and present a challenge to maintain antimicrobial therapy at the forefront of public health control. The endlessly escalating resistance of STD pathogens to antimicrobial agents is a worldwide problem. Antibiotics those have lost their effectiveness are replaced by new drugs, but new strains appear with new determinants of resistance; this issue applies to all classes of drugs. The increase in the resistance and diversity of the drugs used in clinical practice leads to the emergence of bacteria with multidrug resistance (MDR).

Conclusion: The prevalence of infections is still significant among female patients visiting Obstetrics& Gynecology Departments. The study underpins the need to conduct diagnostic assays for identification of causative pathogen before implementing antibiotic treatment to patients with vaginal discharge. It also divulges the need to review the use of syndromic case management for controlling sexually transmitted diseases.

Subash C. Sonkar, Ph.D
LMIC Fellow at Public Health Research Institute of India, Mysore., GHES Fellow at Florida International University, USA.

June 01, 2018

Reference:

Sci Rep. 2017 May 3;7(1):1465.
Evaluating the utility of syndromic case management for three sexually transmitted infections in women visiting hospitals in Delhi, India.

https://www.ncbi.nlm.nih.gov/pubmed/28469158

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