Antibiotics have long been a fundamental pillar of healthcare. Nevertheless, worldwide in recent years the danger of  over-prescription of antibiotics, which led to numerous problems, including antimicrobial resistance and the rise of super bugs, has been acknowledged.

This problem was addressed recently in Egypt through the “Anti-Infective Stewardship Programme” (AISP) initiative.

The initiative, led by the Ministry of Health, was a collaborative effort comprising the Egyptian Society of Surgeons (ESS), the Egyptian Scientific Society of Bronchology (ESB), the Egyptian Pediatric Association (EPA) and the Egyptian Rhinology Society (ERS), as well as private sector pharmaceutical company Sandoz.

Microbe resistance decoded

Dr Abdel Moety Hussein, professor of surgery at Cairo University, explained the concept of antimicrobial resistance, which occurs when bacteria acquire protective properties, rendering some antibiotics ineffective against a certain infection.

“Many mistakes and misconceptions contribute to this problem. A patient’s failure to comply with the prescribed course of treatment may result in bacterial infection recurrence. Just because the symptoms of an illness have disappeared, does not mean that all germs have been killed.

"On another note, even doctors make mistakes, one of which is over giving patients antibiotics after operations, when they should be only given them during or before operating,” he underlined.

Double-edged sword

The dilemma of using antibiotics was the main topic of discussion. Dr Reda Kamel, professor of rhinology at Cairo University, explained how the miracle of the invention of antibiotics changed the world, before presenting other problems.

"We understand how antibiotics impacted heath and mortality at a certain time. They literally saved humanity. We now say that cardiovascular diseases and cancer are top causes of deaths worldwide, but in the past people died in scores due to bacterial infections.

“Nevertheless, we have to understand that respecting antibiotics means using them wisely, as the latest research by WHO (the World Health Organisation) points out that overuse of antibiotics will cause 10 million more deaths by 2015, four million of which are in Africa," he said.

Respiratory tract death toll

Raising awareness on proper diagnosis and treatment of lower respiratory tract infections was emphasized by Dr Adel Khattab, professor of pulmonary medicine at Ain Shams University.

Khattab stated that according to WHO, lower respiratory tract infection deaths exceed the death toll of AIDS, meningitis, hepatitis and tuberculosis, killing 4.2 million each year.

"In Egypt, lower respiratory tract infections were the fifth leading cause of death in 2017 and the third leading cause of premature death. Pneumonia kills more people in Egypt than liver cancer and road accidents. The disease also adversely impacts student achievement and the country's economy as it lowers productivity," he said.

Dr Sherif Abdel Aal, consultant pediatrician at Cairo University, shed further light on the problem.

“Widely considered the primary cause of death among children under the age of five, pneumonia mostly affects developing countries, and statistics have shown that nearly 900,000 children died of the disease in 2017. In Egypt, pneumonia affects one in every 12 children, mainly during the first year of life,” Abdel Aal said.

He hailed the AISP initiative, saying, “We are very happy to be part of an ambitious and dynamic medical community working to achieve a vision of healthy societies, joining forces with four scientific societies to reach a consensus on recommendations for the optimal diagnosis and treatment of numerous infectious diseases, especially pneumonia, and part of the solution is proper diagnosis and optimal use of antibiotics.”

Government on board

Ghada Ali, head of the hospital pharmacy administration division at the Ministry of Health, explained that because the government understands fully the importance of the issue, it was involved from the beginning.

"From 2017 till 2019, a survey of nine governorates spanning from Cairo to Upper Egypt gave the ministry a deep insight into the quantities and kinds of antibiotics misused and overused in Egypt.

"We issued guidelines and raised awareness with doctors in 58 hospitals all over the country, and heavy restrictions were imposed on the prescription of certain antibiotics that came on top of the list of overuse," she said.

The AISP initiative was highlighted further by Thodoris Dimopoulos, head of Sandoz North East Africa, who underscored the importance of expanding awareness and sharing vital updates on the diagnosis and management of infectious diseases via diverse educational channels.