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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