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Interdisciplinary cooperation called on to combat antimicrobial resistance

Rachel Soon
Medical Writer
07 Jun 2018
Dr Christopher Lee, national advisor on infectious diseases for the Ministry of Health.

Coordination between healthcare professionals and those outside it will be employed to comprehensively tackle antimicrobial resistance (AMR) on a national scale, says an expert.

According to Dr Christopher Lee, national advisor on infectious diseases for the Ministry of Health (MOH), AMR is a complex problem that requires a multi-sectoral, ‘One Health’ approach as AMR stems from misuse not only in the healthcare setting, but in animal husbandry, aquaculture, horticulture and communities as well.

“Because the same classes of antimicrobial agents are used in different sectors, any use will select for resistance,” said Lee, who is also senior infectious disease consultant and head of the department of medicine at Hospital Sungai Buloh. “Resistant bacteria and resistant genes do not recognize borders. Many of us are doing some work in AMR, but whether it’s cohesive or strategic enough, that’s something we have to ask ourselves.”

Speaking at the 1st Pharmacist Annual Scientific Meeting on Antimicrobials (PASMA) held recently in Selangor, Lee added that the World Health Organization (WHO), Food and Agriculture Organization (FAO), World Organization for Animal Health (OIE) and other high-level forums had recently adopted ‘One Health’ resolutions on combating AMR in the same year.

On the local level, the Malaysian Action Plan on Antimicrobial Resistance (MyAP-AMR) was developed between 2016 and 2017 in a joint effort between the Ministry of Health and the Ministry of Agriculture and Agro-based Industry to align the country with the United Nations-led action plan against AMR. Launched in February 2018, the MyAP-AMR is headed by a joint secretariat of government officers from the MOH, the Department of Veterinary Services (DVS) and the Department of Fisheries (DOF).

“A ‘One Health’ approach recognizes the relationships between the human, animal and environmental health, and applies interdisciplinary tools to solve complex public health problems,” said Lee. “As such, the MyAP aims to establish a governance mechanism for all participating sectors for situational analyses, planning, implementation and periodic reviews.”

Lee added while there was a lack on data on the extent of the crossover between agricultural antibiotic use and resistance in the Malaysian context, enough evidence was present from across the globe to justify bringing in other sectors in tackling the problem.

“There has been progress, but what needs to be done is to expand what’s being done, to move up the level of intervention and go into new departments,” said Lee.

At a forum conducted the same event, Lee emphasized the need for pharmacists, particularly those in the public sector, to be the ones to step into antibiotic stewardship roles, calling out poor or excessive use of antibiotics in healthcare facilities.

Lee noted one of the stumbling blocks of implementing AMR practice was getting compliance from consultants, who work as independent contractors to healthcare institutions rather than full staff, and thus often did not comply thoroughly with institutional guidelines on the use of antibiotics.

“We’re running out of drugs really fast,” said Lee. “If we stop being stringent in monitoring in the public sector, it will be difficult for our colleagues in the private sector to do anything. […] all of us need to be a little bit brave. The momentum is high; so are expectations.”

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Prof. Cheuk-Chun Szeto, Dr. Winston W. S. Fung, 25 Jan 2018
A 65-year-old lady with a background of type 2 diabetes, hyperlipidaemia and chronic immune thrombocytopenia presented to us with a 2-week history of generalized malaise and myalgia. Shortly after the onset of myalgia, she was noted to have reduced urine output and the urine was described as dark in colour. Her regular medications included prednisolone, danazol, simvastatin, metformin, and human insulin. Upon further questioning, the patient admitted that her compliance to simvastatin and danazol used to be poor. However, she recently started to take both medications regularly after repeated education.
Pearl Toh, 30 Jan 2018
Use of statins may not be neuroprotective, in contrast to findings from previous observational studies. On the contrary, fungus-derived or lipophilic statins appeared to be associated with a slightly increased risk of Alzheimer's disease (AD) compared with synthetic and hydrophilic statins, suggests a new study based on real-world clinical practice data.
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Hoo Yee Yin, 05 Jun 2018
Enteral nutrition (EN) is also known as tube feeding. It is nutrition provided through the gastrointestinal (GI) tract via a tube, catheter, or stoma that delivers nutrients distal to the oral cavity.