Superbugs versus antibiotics

Health concern: Superbugs could pose a serious health threat across all age and socio-economic groups. Picture: ANTOINE DE RAS

Health concern: Superbugs could pose a serious health threat across all age and socio-economic groups. Picture: ANTOINE DE RAS

Published Apr 10, 2014

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Cape Town - The war is on – superbugs versus antibiotics. Director-general of Health Precious Matsoso has expressed concern over “superbugs” which have outsmarted antibiotics and which could pose a severe threat to adults and children alike if something isn’t done.

Matsoso’s spokesperson, Popo Maja, confirmed on Wednesday that “a consultative meeting had been convened to discuss and agree on strategy to deal with this health issue”, while Mark Nicol, professor of medical microbiology at UCT, said the meeting was called to “make sure people use antibiotics correctly as there is a recognition that they pose a threat to public health”.

He says the fundamental problem is that “people use antibiotics irresponsibly and similarly, people in hospital are increasingly using them to provide protection from the prospect of bugs”.

But, he explains, it is not only people who have used antibiotics who are vulnerable to superbugs. Once they have developed, any person can get them.

“A child who goes to crèche can get an ear infection caused by a superbug that has evolved from other children being given too many antibiotics.

“And that is why it is very difficult for health-care professionals to make decisions for each patient when it comes to antibiotics: you want to use a broad spectrum antibiotic for your patient to make them better, but it is the wrong decision for the community at large as resistant superbugs develop and get easily transmitted to others.”

In South Africa and other African countries, clinical decisions around antibiotics can be further complicated by serious health conditions which threaten a child’s life and which need to be diagnosed accurately.

The World Health Organisation, for example, advised health-care professionals at the end of last year that the “proactive use of antibiotics is important in a child who is severely malnourished because the immune system can virtually shut down” but it also goes on to caution that “the new recommendation is specifically for children with severe acute malnutrition – not those who are simply undernourished”.

It says that the widespread use of antibiotics among children who do not need them would increase the risk of infections becoming resistant to lifesaving antibiotics – a situation that would harm the health and survival of all children.

Another disease in the region that has also complicated the use of antibiotics is malaria. According to research published in the New England Journal of Medicine, malaria has been so prevalent in many African countries until recently that health workers assumed any child with a fever had it.

But, after a decade of intensive efforts and billions of dollars of global investment, malaria rates are declining across the continent and, as a result, antibiotics have become the automatic choice for treating a child with a fever – giving rise to new drug-resistant bacteria.

At present, South Africa’s most resistant superbugs are still mainly present in hospital settings and are not highly prevalent in communities.

Says Nicol, “If you’re in the community and you’re a healthy person, you are unlikely to get something like klebsiella,” says Nicol, “but a person in the intensive care unit (ICU) is going to get gram-negative organisms (drug-resistant superbugs) if it is present.”

Outbreaks of klebsiella have been recorded across the globe, with South Africa having its first case last year of a patient with a klebsiella pneumonia that was resistant to all antibiotics. In other countries, ICUs have had to be closed down because of how serious a threat it is.

Health-e News reported earlier this week that a man in his eighties was in hospital for heart surgery when doctors discovered that his klebsiella pneumonia bacteria was resistant to all available antibiotics. The report also said Matsoso had described the emergence of superbugs immune to medicines as “worse than Aids”.

Says Judy Andrew, a former primary school teacher: “In schools in poorer areas and rural areas, parents often send their sick children to school because there is no one to care for them at home.

“This leads to the spread of sickness very rapidly throughout the school. The mind boggles at the absenteeism that would occur should these ‘superbugs’ begin to spread.”

And, she adds, “good nutrition in these poorer schools is often lacking, resulting in children being much more vulnerable to diseases”.

With such a “vicious cycle” at play, only time will tell how it comes to affect South Africa, but, warns Nicol, “while highly resistant superbugs are primarily restricted to hospitalised patients at present, the bugs are becoming more and more resistant.

“This is a concern throughout the world as they are going to pose a major challenge to treating a whole lot of infectious diseases over time.” - Cape Times

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l Farber’s post is funded by the DG Murray Trust. She covers early childhood development and related issues.

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