Sunday, April 17, 2016

Malaysia - Action needed to tackle threat of antimicrobial resistance

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KUALA LUMPUR: Malaysia has called for coherent, comprehensive and integrated global, regional and national level actions to tackle the alarming global public health threat of Antimicrobial Resistance (AMR).

Health Minister Datuk Seri Dr S. Subramaniam said this could be done through a “One Health” approach to address the problem in different sectors such as human and veterinary medicine as well as the agricultural sector.

“We all know that antimicrobials used for the treatment of animals, also belong to classes that are used in human medicine. “Hence, the control of antibiotic use along the food chain, from the farm to the table is essential,” he said in his keynote address on AMR and challenges in Malaysia at the Tokyo Meeting of Health Ministers on AMR in Asia today.

Dr Subramaniam also said legislations needed to be strengthened to ensure that only registered antibiotics were used in both human and animal health. “We should take cognizance of the fact that there is high usage of antibiotics in agriculture and evidence that resistance that emerged from agriculture use can be transferred to man and may cause treatment failure of clinically significant infections. “Measures are being taken in Malaysia to control antimicrobial usage in the farms. This includes control of antibiotics in animal feed where the manner of inclusion and the levels of antibiotics are in accordance to the Animal Feed Act 2009.”

Dr Subramaniam said AMR is at a worrying level worldwide, including in Malaysia, due to the frequent and widespread use and abuse of antibiotics. He said the rapid emergence and spread of AMR presents serious challenges to healthcare systems and threatens the ability of antimicrobials to effectively treat severe infections. “Previously, antibiotic resistance was overcome by the development and usage of newer and broader spectrum antibiotics. “Unfortunately we have exhausted the current available antibiotics and to compound the problem, no new antibiotics seem available in the horizon. “Hence, we are facing the dangerous risk of encountering an infection for which an effective antibiotic might not be available.”

Malaysia, he said, had taken steps to safeguard the effectiveness of antimicrobials by initiating the Antimicrobial Stewardship Programme in all government healthcare facilities to promote the judicious use of antibiotic among prescribers and dispensers. Dr Subramaniam said the programme would be expanded to private health facilities by including Antimicrobial Stewardship activities in the Hospital Accreditation Program. “To ensure a concerted effort in controlling the use of antibiotics in healthcare facilities, the Health Ministry has developed the National Antibiotic Guidelines and the Antimicrobial Stewardship Protocol, to be used as standard reference.”

Dr Subramaniam said the use of antimicrobials tends to increase in parallel with economic growth. The increase usage, he said, would ultimately lead to increase in AMR if effective control measures were not in place. “This is indeed a global challenge. The high rate of antimicrobial usage in hospitals, combined with inadequate infection control measures have led to alarmingly high prevalence rates of resistance in nosocomial setting. “On the domestic front, Malaysia acknowledges the need to control antimicrobial usage, both for human and animal use. “Regular audits on antibiotic usage are carried out in Malaysian hospitals and interventions done to ensure the appropriate use of antibiotics. Infection and Antibiotic Control Committees are formed in every hospital to encourage development and use of guidelines and treatment algorithms.”

Dr Subramaniam also stressed on the need to have good surveillance system on AMR. He said the rapid global spread of bacteria carrying the multi-antibiotic resistant New Delhi metallo-beta-lactamase-1 (NDM-1) gene was an indication that a standardised global surveillance of antibiotic resistance was needed urgently. “Sharing of data on the increasing trends of resistance to specific antibiotics can serve an early warning. “National policies can then be formulated to arrest or reverse such trends.

Malaysia has established a National Surveillance of Antibiotic Resistance program since 1997 to monitor the emergence and spread of multi-drug resistant bacteria, and observe trends and patterns in government hospitals and the community. “We have noticed an increasing trend of resistance to pathogens acquired in the hospitals and also resistance of bacteria normally acquired in the community.”

Dr Subramaniam added that regulation and enforcement of relevant products must be strengthened especially on the prescription on human and veterinary medicines. “We recognise the need to reduce the impact of AMR on morbidity, mortality and related direct and indirect costs and burden on health systems. “Inter-sectorial collaborations are needed to collate and share evidence on the trends of drug-resistant infections and the use of antimicrobials in all the related sectors. “Infection prevention and control, antimicrobial stewardship programmes, as well as the rational use of antimicrobials will be the driving force to contain antimicrobial resistance.”

The meeting in Tokyo aimed to share experiences and identify approaches and attributes for developing national multisectoral plans to combat AMR and to frame a ministerial statement to promote the AMR agenda to be presented at the G7 summit in May 2016.

By Tharanya Arumugam

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