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Drug resistance in crosshairs

A person in Phnom Penh packs pills, including antibiotics
A person in Phnom Penh packs pills, including antibiotics, into medication packages at a pharmacy last year. The high misuse of drugs and the high availability of over-the-counter antibiotics correlates with anti-microbial resistance which is prevalent in developing countries. Pha Lina

Drug resistance in crosshairs

The Ministry of Health (MoH), World Health Organization (WHO) and their partners today released the first ever national strategy to combat antimicrobial resistance (AMR) in Cambodia – a growing problem that experts say is a major threat to public health.

AMR occurs when a microbe becomes impervious to anti-fungal, anti-viral, anti-protozoal and anti-bacterial agents used to treat infections, a massive problem in Cambodia, where studies have shown up to 55 per cent of subjects to be immune to certain medicines.

The Kingdom’s strategy focuses on tackling resistance to antibiotics, which are drugs used to treat bacterial infections.

“This is a problem everywhere, especially in developing countries . . . and the magnitude of the problem correlates with the high misuse of drugs and the higher availability over the counter, two things that are very prevalent in Cambodia,” said WHO emerging disease surveillance and response technical officer Dr Alex Costa.

“Antibiotics affect everyone and are used by everyone, but [currently] no one is responsible for it,” he added.

Resistance often occurs when patients fail to complete a course of antibiotics, leaving some of the bacteria alive while allowing them to adapt to the medication. Repeatedly attempting to use the same medications on people who show an immunity only strengthens the microbe’s resistance.

“Clinicians are not using hospitals’ microbiology labs and are treating the patients [based on past experience], so when they finally go to the labs, they have already produced higher resistance,” said Joanne Letchford, chief scientific officer of Diagnostic Microbiology Development Program, which helped establish all six of Cambodia’s microbiology laboratories in hospitals. “We need the Ministry of Health to encourage the use of this service.”

The Health Ministry’s Department of Hospital Services director Sok Srun confirmed that the Kingdom “certainly has widespread AMR” according to regional reports, and the development of the new policy and strategy is Cambodia’s first attempt to address the growing issue nationally.

“We want to make it a priority, but it will take time before that happens,” Srun said, saying there was a need to “convince the whole ministry and other leaders that this is a big threat”.

According to data from the National Institute of Public Health from a limited sample group in 2013, resistance to some antibiotics has reached a troubling rate.

About half of patients were immune to the drugs used to treat E.coli. Among patients infected with the staphylococcus aureus bacteria – which causes boils, impetigo, food poisoning and cellulitis – 56 per cent were found to be resistant to the antibiotic methicillin.

Under the new policy, the MoH and its partners intend to raise awareness about AMR, implement a standardised surveillance system, enforce quality assurance of antimicrobial medicines available in the Kingdom and expand laboratory capacity.

Most of these initial initiatives, Srun said, will be funded by development organisations until the MoH commits a portion of its budget to AMR.

Cambodia is currently one out of only three Western-Pacific countries that has both a strategy and policy devoted to preventing the spread of AMR.

“In some ways, Cambodia is setting the example for what’s possible to do with limited resources,” the WHO’s Costa said. “But without coordination, it will fail.”

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