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English review - Antibiotic Resistance: A Silent Pandemic?

On Wednesday, October 14, 2020, physician Souha Kanj, clinical microbiologist Heiman Wertheim and conflict scholar Nora Stel talked about the fight against antimicrobial resistance, the refugee situation in Lebanon and their access to public health, and the position of women in medical science . Professor Kanj is the head of the division of infectious diseases of the American University Medical Center of Beirut in Lebanon, one of the oldest universities in Arabic countries. The discussion was led by philosopher Frank van Caspel.

Infectious Disease Shifted Focus on Covid19

The current pandemic has largely influenced medical institutions in the Arabic region, Professor Kanj shared with the online audience.  Since the beginning of the pandemic the focus of Professor Kanj and the Medical Center she works for has also shifted towards the coronavirus, leaving not much time for other projects. "Clinically we have been very busy with a large number of (coronavirus) infected patients. The pandemic has taken us a bit away from other research projects that we have been doing. But we also try to focus on some Covid-related research."

Instead of looking at the negative influence of the Covid crisis, Professor Kanj choses to stay positive and make the best out of adverse conditions, "We are looking at AI for the diagnosis on CT scans with Covid19.” Though the project being still in its infancy, Kanj believes that, with the help of AI, the overwhelming pressure on clinicians could be much relieved.

Antibiotic-resistance, Severe Hidden Danger for Everyone

But people should never ignore the severe hidden danger of antibiotic-resistance, even when facing a global pandemic. The spread of antibiotic-resistant bacteria and its possibly grave implications pose a serious threat to public health worldwide. The concern of antibiotic-resistance has expanded from the medical field to the whole society.

“In 2020, this is a problem that everyone should be aware of,” said Professor Kanj.  "Nowadays, every type of bacteria has managed to develop resistance. Not only narrow-spectrum antibiotics, but even broad-spectrum antibiotics." She also worried that, with some bacteria becoming “super drug-resistant,” we will be facing losing patients, not to their disease, but to an infection after successful treatment. “Medical organizations worldwide sent an alarm that we have reached a point where everyone should make an effort to curtail antibiotic-resistance,” she urged.

Antibiotics Stewardship, Minimizing Antibiotics Usage

Specialists like  Souha Kanj are promoting "antibiotics stewardship," a method focusing on controlling and minimizing antibiotics consumption. "Sometimes you don't need the big gun for small problems," said professor Kanj, explaining the crux of the matter, "and everyone has responsibility."

We cannot attribute antibiotic-resistance to one single cause, Kanj warned us. The problem arose partly through the imprudent action of physicians who prescribe antibiotics haphazardly. Patients themselves also play a major role too, because they don't take their antibiotics the way they were supposed to. And, as many people may ignore, there is a large consumption of antibiotics in veterinary medicine, as well as agriculture. "That is why major organizations are speaking about a 'one-health approach,' which aims to tackle the problem not just from the part of human medicine."

Global Efforts

“Is there any scalable change that can be made?”, asked microbiologist Heiman Wertheim. As at this question, professor Kanj responded: “The antibiotic resistance problem has reached a level where it requires global actions [for change] to have an impact.” People have been devoting local and regional efforts throughout the years, but not much work has been done at the global level, Kanj explained. "We need many factors to help us achieve this." She also mentioned that in Arabic regions, people had no idea of the scale of antibiotic resistance, no data, not to mention a workable solution. "Rapid diagnostic and laboratory methods are very much needed," especially in less developed regions.

It is global concern, therefore, that is  required when facing antibiotic-resistance, especially outside developed countries." A quarter of Lebanon's population is refugee. These people live in suboptimal conditions. And with the current political unrest and total economic collapse, the situation is bad on many levels. NGOs are particularly addressing their health and resources problems, but the challenges remain very big," Kanj told conflict analist Nora Stel. In difficult situations like these, professor Kanj encourages especially women leaders in medicine to stay strong and make a difference.

"Funds are also in demand, especially for developing new antibiotics." That is why Kanj thought that pharmaceutical companies play a positive role in this fight against resistance. "They are the ones still invested in bringing new antibiotics to the market." A lot of companies have abandoned antibiotics because the profitability was not as impressive as that of other drugs. "And this is understandable: people take antidiabetics for life, but antibiotics for only two weeks." Because the problem is multifaceted, increasing education for all those involved in public communication can also play a major role.

Bacteriophage, Old way, New Hope

Upon being asked about the application of new methods such as bacteriophage,  professor Kanj explained that bacteriophage was actually an old way to deal with bacteria. "It was widely used and most effective, but with the discovery of potent antibiotics, people put bacteriophages behind." Now, with the emergency of pan drug-resistant bacteria, some express new interest in bacteriophages. One of the advantages of this therapy is that they are able to break through the protective biofilms of bacteria and deliver promising results, Kanj told the participants. Kanj pointed out that the vital importance of antibiotics in modern medicine has led to a diminished attention to other less conventional approaches. “The likelihood of bacteria growing resistant to bacteriophages is very low, if it does happen at all,” Souja Kanj concluded.

This report was written by Yuting Wang, as part of the Research Master Philosophy of the Radboud University.