Greater patient awareness and stricter control of antibiotic prescriptions are among the keys to fighting anti-microbial resistance (AMR) in Mexico, according to panelists discussing the topic at Mexico Health Summit 2017 on Thursday at the Hotel Sheraton Maria Isabel in Mexico City.
The panel consisted of moderator Gerry Eijkemans, Mexico Representative of the WHO/PAHO; Rafael Gual, Director General of CANIFARMA; Maarten Pouw, Director General of DSM Sinochem Pharmaceuticals Mexico; Juan Pablo Solís, Vice President and General Manager Mexico, Central America and the Caribbean of Becton Dickinson; and Rocío Alatorre, Commissioner of Risk Assessment & Management at COFEPRIS.
“A study performed by the Antimicrobial Review and KPMG shows that there will be 10 million deaths per year globally in 2050,” said Pouw, explaining that antibiotics in the environment also reach the food chain. “Bacteria have no borders and can reach the whole world in two years,” he added.
Alatorre explained that Mexico has established a national plan to combat antimicrobial resistance that involves multiple sectors. “It would be interesting to see if there is a certain legislation needed that we have not yet developed. If the industry can spot gaps in regulation, we will happily review it,” she said.
The general feeling that this is not the sole responsibility of one sector was summed up by Solís: “This is a multifactorial problem, it is not something that can be solved alone. We must work as a team.” He said that medical devices could play an important role in helping identify and diagnose AMR. “If we do not take the appropriate precautions, we could be a vehicle for infection.”
Panelists lamented the general population’s attitude toward antibiotics, requesting them when not needed and not finishing prescription courses. “90 percent of ear infections are caused by a virus, yet doctors prescribe antibiotics,” said Pouw. Alatorre added that part of the problem is the lack of awareness in people’s consumption of antibiotics.
Industry professionals are also part of the problem. “Often, pharmacies and doctors in pharmacies prescribe antibiotics without testing,” said Gual, advocating more thorough antibiograms before a prescription is written. Solís pointed out that this is an area in which medical devices could be of use. He added that devices in general now also have better security to help prevent the spread of infection. “Devices have evolved to have presentations that contain active or passive security, such as caps on needles after use. This reduces infections in professionals and patients,” said Solís.
Pouw pointed out that there have been no new classes of antibiotics developed since 1987. “It is easier to protect what we have,” he said. Eijkemans asked what incentives could be put in place to encourage the production of new antibiotics, and Alatorre commented that antibiotics research is no longer a priority for many, but that the government could put incentives in place.
The environment was a final cause for concern. “We need to establish a maximum level of antibiotics in animals destined for meat,” said Alatorre, speaking of synergies between sectors and adding that an integral vision between animal, human and environmental health was key and that Mexico was a leader in Latin America.
Gual explained that waste from pharmaceutical facilities is strictly controlled. “Nothing is overlooked and many times water is recycled and reused. The water the industry throws away is probably cleaner that the water it receives. Antibiotic plants are separate and have many more controls than standard plants,” he said. Added Pouw: “No government establishes maximum limits of antibiotics in waste.” He called for more control globally. “Companies that sell antibiotics in Mexico should certify their waste. The technology is available and is not expensive.”
Solis suggested that as measurement of AMR advances, plans to combat it become more effective. “What is not measured cannot be improved,” he said. “We must be capable of producing a list of the main bacteria that are producing resistance.” COFEPRIS’ Alatorre hinted at an upcoming NOM that would regulate the use of silver to clean water instead of chlorine, which should help with AMR.