Water crisis’ impact on resistance to common antibiotics

“In drought situations one usually sees an increase in the transmission of bacterial and viral infections through food and waterborne processes. Also if people wash their hands less the worry is that we’ll begin to see more diarrhoeal disease in particular,” said antimicrobial resistance (AMR) expert Professor Marc Mendelson, who heads up the University of Cape Town’s infectious diseases division.

According to the World Health Organisation (WHO) AMR is the “ability of a micro-organism (like bacteria, viruses, and some parasites) to stop an antimicrobial (such as antibiotics, antivirals and antimalarials) from working against it”. Germs’ resistance to antibiotics makes standard treatments ineffective and can make common infections harder, and sometimes impossible, to treat.

Antibiotic resistance

Resistance is fuelled by the overuse and improper use of the drugs which allows resistant bacteria to develop and spread. When there are no antibiotics left with the ability to kill bacteria, clinicians are left with few treatment options for patients with resistant infections. Newer antibiotics are not being developed fast enough to outpace the increase in resistance.

Mendelson said that the limited available data shows that “antibiotic resistance is a significant problem in South Africa and we clearly need to do more” to tackle it.

Although Mendelson said there have been no concrete reports of increases in diarrhoeal diseases in the Western Cape since the drought, research from other countries has shown that droughts have the potential to make a serious impact on the development of drug-resistance.

But he said that “just because we haven’t heard about it, it doesn’t mean it hasn’t happened”.

Surge in antibiotic use

He said the concern is that more people than usual will come to clinics with diarrhoea, and other infectious illnesses, and be treated with antibiotics without health workers first finding out whether the infection is bacterial or viral.

“The more you use antibiotics, the more you allow resistant bacteria to develop and then spread in communities,” he explained to Health-e News. “The vast majority of people don’t need antibiotics in these cases because diarrhoeal disease is driven by viruses to a large extent.”

But he said in the absence of quick and easy ways to diagnose whether an infection is bacterial or viral, many clinicians will treat patients with antibiotics.

Need for rapid diagnostics

Drug resistance is in the spotlight as the WHO published its first report on AMR surveillance data that included information on antibiotic resistance from 22 countries.

It revealed high levels of antibiotic resistance in many countries including South Africa and estimated that at least half a million people had resistant infections across the included countries in the 2016/2017 reporting period.

AMR experts met in Khayelitsha on Tuesday (30 January) to launch a partnership between the South African Medical Research Council and the Foundation for Innovative New Diagnostics (FIND) to develop new rapid diagnostics which can help clinicians in low and middle-income countries identify bacterial infections from others and prevent the inappropriate and overuse of antibiotics.

FIND’s chief executive officer Dr Catharina Boehme told Health-e News that the Netherlands was able to halve their use of antibiotics by, in part, scaling up their use of diagnostics.

“Our highest priority is to develop a simple, fast and easy-to-use test to distinguish bacterial from non-bacterial infections that can be used by health workers in communities and in facilities,” she said. “This could be a powerful tool to limit the use of antibiotics. Imposing diagnostics should be the first prescription a patient gets.” – Health-e News.