Scientist says poor quality antibiotics, source of antimicrobial resistance in Ghana
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- 08 Jun 2023
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Professor Christian Agyare, a pharmaceutical microbiologist, suggests that the presence of substandard antibiotics in the market may be a significant factor contributing to antimicrobial resistance in Ghana. Referring to various studies conducted by the Kwame Nkrumah University of Science and Technology (KNUST) College of Health Sciences and other scientists over the past decade, he revealed that a biological assay conducted on penicillins in selected Ghanaian markets showed higher minimum inhibitory concentration (MIC) values compared to reference samples.
Among the 54 samples evaluated, 61.1 percent met the specifications outlined in the British Pharmacopoeia (BP) and United States Pharmacopoeia (USP) monographs. The quality of amoxicillin was found to be superior, with 82.8 percent meeting the standards, while flucloxacillin (31.3 percent) and cloxacillin (44.4 percent) demonstrated lower quality. Professor Agyare, the Provost of the College of Health Sciences, discussed these findings during his presentation on the topic: "Treating Non-Curable Infectious Diseases and Wounds with Natural Knowledge and Products" at a Professorial Inaugural Lecture hosted by KNUST in Kumasi.
Antimicrobial resistance refers to the ability of microorganisms to survive or grow in the presence of drugs intended to inhibit or kill them. This occurs when bacteria and other microbes adapt and become less susceptible to the prescribed treatment. The lecture focused on identifying various sources that contribute to the development of antimicrobial resistance at the local level and explored how natural products could be utilized to modulate antimicrobial resistance for improved therapeutic outcomes. It addressed antimicrobial use in aquaculture, animal husbandry, poultry, and the quality of available antibiotics in the Ghanaian market.
Regarding antimicrobial use in animal husbandry and its implications, Professor Agyare highlighted that many antibiotics used in animal husbandry are also essential medicines for human use. He disclosed that residual levels of these antibiotics in animal, poultry, and fish products, as well as in water bodies and the environment, pose potential risks for the development of microbial resistance. The Provost shared the results of a cross-sectional survey conducted among 400 poultry farms in the Ashanti, Brong-Ahafo, and Greater Accra Regions. The survey revealed that farmers reported using 35 different antimicrobial agents to manage various conditions such as Newcastle disease, fowl pox, coccidiosis, and coryza infections in their farms. Out of these agents, 20 essential antibiotics from 10 antibiotic classes were identified, with tetracyclines (24.17 percent), aminoglycosides (17.87 percent), penicillin (16.51 percent), and fluoroquinolones (10.55 percent) being the most frequently used.
Furthermore, it was observed that only 63 percent of the farms completed the recommended duration of antibiotic courses, 58 percent adhered to the recommended withdrawal periods, and 88 percent sought veterinary advice before administering antibiotics. Farmers had easy access to antibiotics and related information from veterinary offices, vet-chemical stores, and mobile salesmen. Discussing the resistance patterns of bacterial isolates found in drinking water used in poultry production in the Ashanti Region, Professor Agyare highlighted that the study revealed the presence of multi-drug resistant strains, including Escherichia coli, Salmonella typhi, Staphylococcus aureus, and coagulase-negative staphylococci. These strains are responsible for various bacterial infections in humans and animals, and almost 95 percent of the bacterial isolates were found to be multi-drug resistant. The study also showed that total coliforms were present in 97 percent of the samples, while faecal Enterococci were found in 56 percent of the samples.
To ensure the safety of water sources used in animal husbandry, the pharmaceutical biologist cautioned that measures should be taken to prevent pathogenic and resistant bacterial strains from causing infections in animals and farm workers. Prior to identifying the presence of poor-quality antibiotics in the country's drug supply chain, a study was conducted in three hospitals in Kumasi, the capital of the Ashanti Region. This study identified antimicrobial resistance patterns in strains of Staphylococcus aureus, a highly resistant organism. Out of 300 patients, a total of 109 Staphylococcus aureus isolates were obtained from wound and nose swabs. The isolates exhibited varying susceptibility levels, with vancomycin being the most effective (74.1 percent), followed by ceftriaxone (67.6 percent), erythromycin (49.0 percent), ampicillin (47.0 percent), and gentamicin (44.4 percent). Furthermore, 32.1 percent of the Staphylococcus aureus isolates demonstrated multiple drug resistance.
Similarly, a study conducted in fish farms in the Ashanti Region showed varying levels of resistance to over 60 percent of the antibiotics investigated, including penicillins, tetracyclines, sulfonamides, macrolides, cephalosporins, quinolones, and chloramphenicol. The presence of multi-drug resistant bacteria in fish samples, despite farmers reporting no recent use of antibiotics, raised concerns.
Antimicrobial resistance is estimated to cause approximately 700,000 deaths worldwide each year, and all countries are potentially affected. The World Health Organization (WHO) warns that this number could rise to 10 million deaths annually by 2050 if the issue is not effectively addressed. Professor Agyare considers antimicrobial resistance a global threat that must be confronted directly. He emphasizes the need for stringent control over access to antimicrobial agents, involving the combined efforts of regulators, prescribers, pharmacies, and dispensary outlets. Regulatory bodies should enhance surveillance to ensure that antimicrobial products on the market meet the required standards. Additionally, a well-defined policy direction is necessary to improve antimicrobial stewardship.
