Tuesday, January 18, 2011

The APUA African Chapter Network Initiative Uncovers New Data to Guide Improved Antibiotic Therapy

In 2001, APUA set out to develop a chapter network in Sub-Saharan Africa to supplement the limited resources available there to fight high rates of infectious disease. A major focus has been reduction of preventable or easily treatable bacterial diseases such as pneumonia and diarrheal diseases which are prevalent in the general population and often co-infect HIV patients.

Since 2001, APUA has established chapters in Ethiopia, Gambia, Kenya, Mozambique, Namibia, Nigeria, Senegal, South Africa, Tanzania, Uganda, and Zambia, with several more under development. APUA chapters in Zambia and Uganda facilitated introduction of APUA’s recent situation analysis funded by the Bill and Melinda Gates Foundation. With the chapters’ assistance, APUA staff, Dr. Susan Foster and Dr. Aníbal Sosa coordinated in-country research teams of over 100 workers, compiling over 10,000 records from rural and urban sites. At the end of the two year study, country stakeholders were convened to consider implications and recommend interventions.

Key findings from the APUA situation analysis in Zambia and Uganda include:

  1. Health staff are still commonly prescribing the antibiotic cotrimoxazole for acute respiratory infection due to S. pneumoniae — even though resistance levels to this drug are very high and the standard for treatment has been changed to amoxicillin.
  2. Febrile children even with respiratory distress are almost as likely to get a drug meant to treat malaria as they are to get an antibiotic.
  3. In both countries, laboratories need to be upgraded with the proper equipment to collect data on drug resistance rates to various antibiotics and treatment guidelines need to be updated more frequently.

The APUA global chapter network in over 65 countries seeks to improve diagnosis and treatment of infections through improving regulatory policies and clinical practices. The APUA works in close collaboration with other organizations including the WHO, CGD, and the CDC. For more information on the APUA Global Chapter Network see the APUA Chapter Network page on our Web site or to learn more about the Gates Foundation Project in Zambia and Uganda visit our Current Projects page.

1 comment:

  1. The capital of Ugands's main sewer plant off of Old Port Bell and Spring Roads may still send its effluent to Murchison Bay, very near to the fresh water intake for the city. Murchison Bay is a highly confined portion of Lake Victoria and the circulation, hence flushing may be poor to almost non existent. With respect to the spread of antibiotic resistance, it would be prudent for the students at Makerere to run disc-diffusion tests on the local water and to run tests for inclusion of antibiotic resistant genes (ARGs) in the potable supply.

    To facilitate such testing, I would suggest that they contact Dr Amy Pruden and Virginia Tech for protocols on running tests on ARGs.

    The Wastewater Research Division, Municipal Environmental Research Laboratory, U.S. Environmental Protection Agency, Cincinnati, Ohio, notes that: "Several researchers have pointed out that wastewater, treated or untreated, is a primary contributor of bacteria to the aquatic ecosystem (12, 16, 17, 20, 27, 29). Studies have been conducted which demonstrate that significant numbers of multiple drug-resistant coliforms occur
    in rivers (17), bays (9), bathing beaches (28),
    and coastal canals (13). Waters contaminated by
    bacteria capable of transferring drug resistance
    are of great concern since there is the potential for transfer of antibiotic resistance to a pathogenic species."

    Available information shows that conventional
    wastewater purification methods are not adequate for removal of antibiotic-resistant bacteria. The ARGs are not amenable to typical chlorine levels and many filters used by wastewater systems fail to remove ARGs.

    With respect to the use of UV, the EPA study noted-----"It is interesting to note that although there was no significant increase observed in the percentage of streptomycin-resistant total coliforms surviving UV irradiation, the ability of this population to transfer antibiotic resistance increased."

    "For certain antibiotic combinations, selection
    of antibiotic-resistant total coliforms by UV
    treatment is shown in Table 6 for strains isolated on media containing chloramphenicol. Before UV treatment, the strains exhibiting the Sm Te Cm Am and the Sm Te Cm Km Am resistance patterns made up a total of 40% of all isolates.
    After UV treatment, 70% of all isolates from
    media containing chloramphenicol exhibited one
    or the other of these resistance patterns." Reference: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC241834/pdf/aem00183-0119.pdf

    For nations with foreign exchange issues and the need to import expensive pharmaceuticals, it behooves the leaders of those nations to take extra precautions to reduce internal issues that might exacerbate the rising levels of antibiotic resistance.

    Dr. Edo McGowan

    January 24, 2011 1:38 PM