Falling behind: Canada needs a nationwide antimicrobial strategy
In the past year, over 18,000 patients have battled antimicrobial-resistant infections in Canadian hospitals. The number of deaths in Canada due to Clostridium difficile is now almost four times what it was in 1997. Antimicrobial-resistant organisms cost Canadians $1 billion annually.
As medical students, we are aware that patients suffer tremendously and even lose their lives to bugs that were once easily treatable with antimicrobials but are now resistant. More than 100 patients a year die from resistant bacterial infections in Canada. Antimicrobials remain overly used across the country.
It is evident that the Canadian government needs to start treating antimicrobial resistance like the health emergency that it is. The US is investing $1.2 billion into research and development to find new ways to tackle resistant bugs. In 2014, the UK announced a “War Cabinet” to do the same. Canada hopes to somehow keep up with these countries with a mere $4 million investment in research and very few concrete goals or plans.
Taking action on this issue could be a potential political win for Prime Minister Trudeau. The Auditor General’s report last spring emphasized the lack of action Canada has taken to combat resistance, including the absence of a concrete nationwide resistance strategy. Our new government has the opportunity to prioritize this problem and take steps to address the current shortcomings by developing a national antimicrobial strategy.
Research money in proportion to the US and UK funding should be directed at new drug development, but also other areas. We need funding to evaluate health interventions and ensure that they’re being adopted. It’s also vital that we invest in rapid diagnostics to ensure that patients who have drug-resistant infections can be isolated and treated early.
What can health providers, health managers and patients do to support a nationwide antimicrobial strategy? First, we should continue to be mindful of basic infection prevention. This includes strengthening our efforts to promote hand hygiene, safe sex, vaccinations, and food and water safety. It’s simple: when we don’t share bugs, we don’t need drugs.
Second, as health care providers, we need to stop prescribing antibiotics just in case symptoms are due to a bacterial infection. In 2013, 23 million antibiotic prescriptions were written for conditions mainly caused by viruses. This inappropriate and ineffective use of antibiotics drives resistance in bugs. We do not immediately administer clot-dissolving medications to all patients with chest pain just in case they are having a heart attack, nor do we administer chemotherapy to all patients with a palpable mass just in case they have a malignant tumour. We need to be as judicious with antibiotics as we are with other medical therapies.
Furthermore, as patients, we need to stop demanding that our physicians prescribe antibiotics needlessly. When our physicians prescribe antibiotics, we need to ask why and whether antibiotics are truly indicated. When we do need antibiotics, we need to take them as directed. Work on nation-wide public education and awareness of this issue is warranted, much like Canada’s previous work on tobacco education. This education could be delivered in schools, as well as via television, online and print media.
Third, we need to expand antimicrobial stewardship programs in our hospitals and health care settings. A Canada-wide, coordinated effort, including physicians, pharmacists, nurses, dentists, other health providers, patients and policy makers is essential for reducing the acquisition of antimicrobial-resistant bugs. Stricter guidelines must be set and enforced and resistance patterns and rates must be monitored more vigilantly to reduce spread.
The importance of antimicrobial stewardship must be discussed at all levels of care, from students like us, who will be the next generation of prescribers, to department heads. Currently, medical education of antimicrobial resistance is sparse and inconsistent in medical schools, which is why we lead a national student organization aimed at addressing the gap.
And finally, Canada needs to begin more formal and concrete conversations with other countries to determine how the world can work together to curb global resistance rates, strengthen global surveillance, and regulate antimicrobials. These discussions may also include antimicrobial overuse in agriculture, which some European countries have taken concrete steps to address. Some have suggested developing new types of incentives to motivate drug development, while others have encouraged the adoption of an international legal framework. We are falling behind international efforts on this issue. We don’t live in a vacuum. We live in a global community where travel facilitates the rapid spread of bugs worldwide. Now is the time for Canada to work with global partners to develop a coordinated, effective response to antimicrobial resistance.
It is Canada’s duty to wake up and start making some serious changes. It starts with the actions of each Canadian, but it is integral that our institutions, health systems, and government work together to preserve this precious resource. If we do not, it is not a question of whether we will find ourselves in the post-antibiotic era; it is a question of when.
Alainna Jamal, Sarah Silverberg and Wynn Peterson are second-year MD candidates at the University of Toronto and are members of the Students for Antimicrobial Stewardship Society.