Professor Sabiha Essack (B. Pharm., M. Pharm., PhD), Dean of the Faculty of Health Sciences and Professor in the School of Pharmacy and Pharmacology at the University of KwaZulu-Natal is a Welcome Trust Research Fellow who completed research towards her PhD in Pharmaceutical Microbiology at St Bartholomew’s and the Royal London School of Medicine and Dentistry in the United Kingdom. She is also the president of APUA-South Africa.
Antimicrobial resistance is currently the greatest challenge to the effective treatment of infections globally. Resistance adversely affects both clinical and financial therapeutic outcomes with effects ranging from the failure of an individual patient to respond to therapy and the need for expensive and/or toxic alternative drugs to the social costs of higher morbidity and mortality rates, longer durations of hospitalisation, increased health care costs and the need for changes in empirical therapy. Resistance may emerge by selection pressure (overuse/indiscriminate antimicrobial use in developed vs under-use/misuse in developing countries) but is perpetuated by diverse risk factors and maintained within environments as a result of poor infection control. Population-specific drug pharmacokinetics and pharmacodynamics also play a role. The WHO, US, UK and EU have initiated strategies for the containment of resistance, with surveillance critical to all.
Hygiene and sanitation (in communities) and infection control (in hospitals) status must be determined and interventions initiated to prevent the spread of resistance. Pharmacokinetics and pharmacodynamics specific to diverse populations must be devised to optimise antimicrobial therapy. Evidence-based treatment of infections guided by local susceptibility/resistance would ensure productive, economically viable individuals capable of fulfilling their social roles. Efficacious treatment would assure sustainable livelihoods in all populations (healthy and otherwise) as infections are the most frequently encountered health problem even in the absence of HIV/AIDS. While one infection will ultimately be fatal, the efficacious use of antibiotics will successfully treat several infections in the lifetime of the AIDS patient even in the presence of a compromised immune system sustaining the economic viability of the country and preventing the economic collapse portended by the World Bank. South Africa has unique needs in the antimicrobial resistance arena, needs to be addressed in the context of severe financial, human resources and technological challenges.
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