Antibiotic resistance is a serious health threat that puts a strain on Canada’s health care system. The main reasons are the need for more expensive drugs and increased and longer hospital stays.

At Risk Groups

Certain groups are at risk of developing more frequent infections and are thus at risk of getting antibiotic-resistant. Such people may also require more expensive treatments. At risk groups include homeless persons, older people in assisted living facilities, and premature babies whose immune system is not mature yet. Other at risk groups include persons with poor hygiene and people living in day care centres and healthcare facilities. Healthcare professionals are also at risk of more frequent infections, including veterinarians, nurses, and physicians.

Scope

The number of people dying due to antibiotic resistance is unknown but healthcare professionals admit that more people die from infections today compared to 5 years ago. Drug resistance is expected to result in more than 2 million excess deaths in the postindustrial countries, as shown in a document by the Organization for Economic Co-operation and Development, member of which is Canada.

Canada’s Health Care System

Antimicrobial resistance is putting a strain on Canada’s health care system due to the fact that more people need intensive care.  Enterobacteriaceae and other bacteria are now resistant to all or most antibiotics. MRSA or methicillin-resistant Staphylococcus aureus is a serious health threat, and patients are at a 64-percent higher risk of dying compared to patients having the non-resistant strain. In fact, research shows that MRSA alone costs healthcare facilities between $42 and $59 million a year.

What Can Be Done

The key to combating antimicrobial resistance is developing new antibiotics that take between 5 and 10 days to fight an infection. The problem is that pharmaceutical companies are unwilling to invest $1 billion in developing a new drug. Developing medications for chronic conditions is more profitable, especially drugs taken for life for hypertension and high cholesterol. Pharmaceutical companies are also unwilling to invest in developing antibiotics due to the fact that bacteria may develop resistance within a relatively short period of time. This means that concerted effort is required not only in Canada but also globally. In Canada, the provincial and federal governments must focus on policies and programs that encourage manufacturers to develop new antibiotics.

The Canadian government has developed a Federal Action Plan on Antimicrobial Resistance and Use to limit and prevent the spread of antimicrobial resistance. Specific measures have been outlined to be implemented by bodies such as the National Research Council, Canadian Food Inspection Agency, Public Health Agency of Canada, and others. One of the main goals is to develop a pan-Canadian framework in cooperation with industry, animal health, agricultural and healthcare partners at the territorial, provincial, and federal level. Engaging and cooperating with stakeholders is the key to addressing the problem. The focus is on regulation of antibiotics as well as on approval of medications for coverage and delivery of medical services. Existing surveillance systems should also be improved to assess use, the scope of the problem, and emerging threats. Two such systems are functioning in Canada – the Canadian Nosocomial Infection Surveillance Program and Canadian Integrated Program for Antimicrobial Resistance Surveillance. The goal is to improve infection control and prevention across Canada through innovation, advocacy, and collaboration.

While different agencies have been established to limit the spread of antibiotic resistance, financing has been found to be insufficient. Only $6.9 million have been spent on the development and implementation of programs in 2016 – 2017, pointing to the fact that funding is a major issue.

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Antibiotic resistance refers to changes in bacteria that enable them to survive antibiotic exposure. Such bacteria cause infections, increase treatment and recovery times, and lead to higher mortality rates. Close to 1 million patients die each year due to infections that can no longer be successfully treated with a range of antibiotics.

Mechanisms That Bacteria Develop

Bacteria use a number of mechanisms to survive exposure, including changing and destroying antibiotics and releasing enzymes which change drugs so that they become ineffective. Some bacteria such as Pseudomonas aeruginosa use pumps to prevent drugs from entering through their walls. Such drugs are, for example, trimethoprim, chloramphenicol, beta-lactams, and fluoroquinolones.

Resistant Bacteria

Some bacteria have low to medium antibiotic resistance, including mycobacterium tuberculosis, neisseria gonorrhoeae, and streptococcus pyogenes. Such bacteria can be deadly and cause diseases such as gonorrhea, meningitis, tuberculosis, diarrhea, pneumonia, and lung infections. Some bacteria such as Pseudomonas aeruginosa mainly affect people with compromised immune systems, including patients with cystic fibrosis, cancer, and AIDS.

In general, bacteria can be divided into gram negative and gram positive. Enterobacteriaceae are gram negative and are resistant to antibiotics such as nalidixic acid, tetracycline, and ampicillin. Examples of gram positive bacteria include Streptococcus, Mycoplasma genitalium, Enterococcus, and Clostridium difficile. They cause diseases such as peritonitis, otitis media, arthritis, and bacteremia and are resistant to a number of antibiotics, including tetracycline, methicillin, penicillin, and erythromycin.

Scope and Prevention

One of the main problems is that in some parts of the world, antibiotics are sold without prescription. Countries where it is easy to obtain medications without a prescription include Ethiopia, Saudi Arabia, Syria, and Indonesia. Studies show that antibiotics offered without a prescription include azithromycin and amoxicillin. Amoxicillin, for example, is used to treat a number of infections such as skin, stomach, and respiratory infections, including pneumonia and bacterial sinusitis. Azithromycin is also used to treat bacterial infections such as intestinal infections, traveler’s diarrhea, pneumonia, strep throat, and middle ear infections. The use of such critically important medications without a prescription results in antibiotic resistance. This is considered a major health threat in light of the fact that antibiotics are used to treat multiple serious bacterial infections. Prevention is the key to reducing the spread of resistance. This can be done by educating patients and making information widely available. Policy makers must develop and improve plans, programs, and policies as well as strategies for control and prevention. It is also important to develop policies to regulate prescription, disposal, and use of antibiotics. The general public is advised to keep immunizations to date, limit contact with sick persons, handle and prepare food safely, and frequently wash hands. Antibiotics must only be used as and when prescribed. Over-use by patients and over-prescription by health professionals are major problems that require urgent and comprehensive measures. Health professionals are advised to monitor and report on infections, prescribe medications as per national standards and guidelines, and keep their work environment and instruments clean. They are also advised to discuss with patients the ways to prevent infections, including hand washing and vaccinations. It is also important that the research community focuses more on the development of diagnostic methods and tools and on new antibiotics that can effectively treat serious and life-threatening infections.