Antibiotic abuse and resistance a silent pandemic. AMR Guidelines and Safeguards and its implications for Medical Value Travel Potential and Patient

Antibiotic abuse and resistance a silent pandemic.

AMR Guidelines and Safeguards and its implications for Medical Value Travel Potential and Patients

Antimicrobial resistance (AMR) has spread globally and resemble a silent hidden killer pandemic. Irrational use of antimicrobials in community health settings, agriculture and animal husbandry is largely responsible for the increase and spread of antimicrobial resistant pathogens. This global issue is further compounded by increased international travel, lack of vaccines and novel antimicrobials against the resistant pathogens.

Medical value travel is gaining strategic importance as patients travel across countries for medical treatment. AMR guidelines recommends development and support in genomic surveillance for global control of AMR. The human microbial flora also plays a key role in the spread of AMR and needs to be studied in international travelers. These travelers need to be screened thoroughly using samples from stools, nasal, vagina and skin for detection of AMR genes. Stringent antimicrobial stewardship practices need to be followed by clinicians who are providing pretravel consultation and treatment to this diverse group of traveling population. Rational use of antimicrobials during empirical therapy and preoperative prophylaxis especially needs to be given specific attention. The medical travelers need to be educated on the risk of various diseases in the countries they are traveling. Similarly, Vaccinations, travel medications and precautionary measures should be arranged prior to the medical travel.

There are several potential solutions to the public health and economic implications of the increase in spread of present and potential antimicrobial resistant pathogens. These solutions include: containment strategies implemented by the World Health Organization (WHO) under the International Health Regulations 2005 (IHR); race-to-the-top strategies that do not require state intervention at any level, where patients select hospitals with expertise in infectious diseases; containment procedures utilized by individual countries to prevent incoming infections, similar to the classical IHR regime; and information-forcing regimes at either national or international levels, which can supplement any of the other three regulatory and economic solutions by instituting reporting requirements on individual states.

There is huge lack of data regarding healthcare associated infections and antimicrobial resistance due to medical travel. A holistic antimicrobial stewardship approach at global level in medical value travel is an urgent need of the hour to tackle the menace of antimicrobial resistance.

# Antimicrobial resistance # Medical value travel # healthcare associated infections

References:

1.      Antimicrobial resistance: global report on surveillance. World Health Organization 2014. Online. Available at: https://www.who.int/publications/i/item/ 9789241564748.

2.      Hassing RJ, Alsma J, Arcilla MS, Genderen PJ, Stricker BH, Verbon A. International travel and acquisition of multidrug-resistant Enterobacteriaceae: a systematic review. Eurosurveillance 2015; 20. Available at: https://doi.org/10.2807/1560-7917.ES.2015.20.47.30074.

3.      World Health Organization. Global Action Plan on Antimicrobial Resistance; World Health Organization: Geneva, Switzerland, 2015.

4.      Hill, Tamara L. "The Spread of Antibiotic-Resistant Bacteria through Medical Tourism and Transmission Prevention Under the International Health Regulations," Chicago Journal of International Law: Vol. 12: No. 1, Article 11,2011.

Dr Rahul S Kamble

MBBS, MD Microbiology

Diploma Infectious Diseases (UNSW, Australia)

Infection Control course (Harvard Medical School, USA)

International Clinical Tropical Medicine course

(CMC Vellore| Haukeland university| McGill university)

International Vaccinology course (CMC Vellore)

Six Sigma Black Belt (Govt of India certified)

Auditor: JCI| NABH| NABL| CSSD| RBNQA| Texila university

PGDBA|PGDHM|PGDCR|PGDMR|PGDOM|

PGDMLS|PGDIM|PGDHI|PGDBI|PGDHA|CCDHHO

Consultant Clinical Microbiologist & Infectious Diseases

Project Lead - Antimicrobial Stewardship