Middle East combat doctors alarmed at resistance to antibiotics

doctors surgeryDoctors who treat victims of Middle East conflicts have expressed alarm at the ineffectiveness of antibiotics, which are too readily available without prescriptions in regional pharmacies.

Overuse of antibiotics can make bacteria resistant to them and doctors say this contributes to the evolution of “superbugs”.

“The situation is terrifying,” said Dr Rasheed Fakhri. “The problem is the effectiveness of generations of antibiotics is decreasing so new generations are very limited by comparison.

“The level of education and acceptance by populations, even by medical teams, for respecting antibiotic prescriptions is not high enough.”

Dr Fakhri was recruited by the Dubai office of Medicins Sans Frontieres (MSF), the volunteer group that treats patients with combat injuries, to work in a reconstruction hospital in Amman, Jordan.

MSF’s project to treat patients with combat injuries began a decade ago, but in that time Dr Fakhri has witnessed a worrying level of bacterial resistance.

Some pharmacists in Abu Dhabi and Dubai hand out antibiotics without prescriptions to treat minor ailments.

“Many patients do not often challenge the need for a prescription from a pharmacy for these kind of drugs,” said Dr Arthur Williams, a family medicine specialist at the American Spine Centre in Dubai.

“Antibiotics should only be prescribed in accordance with illness and by medical professionals. A lot of work is needed here on awareness in the UAE.”

Dr Fakhri’s hospital treats patients who have injuries such as loss of limbs, but sometimes 18 months after they sustained the wounds.

Between 50 and 60 per cent of orthopaedic patients are from Iraq, Yemen, Syria and Jordan.

Drug-resistant bacteria has been steadily increasing since 2009, doctors at the hospital said.

One infection that is hard to treat is war-related osteomyelitis, which is found in the bones of casualties.

There have been six recorded hospital cases where the bug is resistant to all available drugs – four of them in the past 12 months.

Dr Fakhri, who has also worked in Iraq, said: “I am not optimistic that there is a significant strategy to tackle the issues we are facing as a result in these countries.

“We have a very specific war injury in Iraq and Syria [osteomyelitis], so antibiotic resistance is not a direct result of malpractice by doctors.

“But it is a concern for the future as such practices will lead to the development of resistant bacteria. There should be more government control over antibiotics.”

Syrian patient Oday suffered several bullet wounds to his right leg in Duma, Damascus, in November 2012. He was treated in a field hospital but developed severe bone infection osteomyelitis.

Bone samples showed very resistant types of bacteria that could not be treated by the usual antibiotics.

Surgery was done to remove the infected area, with a longer course of stronger antibiotics to stop further infection.

MSF findings support a strong link between war-associated injuries and infection with drug-resistant organisms. To recover, on average, patients need on average at least an extra one or two operations and a six-week course of medication.

“MSF has experienced antibiotic resistance in war-injured Iraqi and Syrian patients in its reconstructive surgery hospital,” said Mohamed Bali, MSF’s executive director in the UAE.

“For a humanitarian surgical project, patients infected with MDR [multiple drug-resistant] organisms lead to formidable diagnostic, treatment, and control challenges. It considered one of the biggest medical humanitarian challenges that MSF is facing in the region.

“Implementing restricted regulations on over-the-counter antibiotic sales and raising consumer awareness to reduce patient demand for antibiotics are critical steps to address antibiotic resistance in the region.”


Source: thenational.ae

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