STATUS OF ANTIBIOTIC RESISTANCE
Antibiotic resistance problems in Argentina stem from:
lack of regulation in human use
lack of regulation in agricultural use
lack of continuing medical education on antibiotic use for prescribers
These problems challenge the ability to effectively treat infectious diseases that are prevalent in Argentina such as tuberculosis, acute respiratory infections, diarrheal diseases, and chagas disease.
APUA Argentina was formed in June 1999 by President Liliana Clara, MD, Head of the Infectious Diseases Section, Hospital Italiano de Buenos Aires, and Secretary Gabriel Levy Hara, MD, Chief of Department of Infectious Diseases, Sanatorio San Patricio, Buenos Aires, Argentina.
Chapter Objectives and Priorities:
The chapter’s activities focus on promoting the rational use of antibiotics in the community and the hospital environment through interaction with national authorities to limit the use of antibiotics.
Future projects that APUA Argentina plans to engage in involve research, surveillance, consumer education, prescriber training, and advocacy. The chapter also plans to work in collaboration with other organizations and develop reports based on their activities.
A brief communication by APUA-Argentina entitled “Antimicrobial Stewardship Programs in a Developing Country: the Epidemiological Barrier” was recently accepted by the Pan-American Journal of Public Health (the official publication of PAHO) and is pending publication. The authors are Dr. Gustavo Lopardo (APUA-Argentina President) and his colleagues from the Hospital Prof. Dr. Bernardo Houssay and the Instituto Sacre Coeur, both in Buenos Aires.
The paper describes the process of developing an antibiotic stewardship program (ASP) in a 140-bed university hospital in Argentina. The authors recognize the benefits of an established ASP – improved clinical outcomes through reduced emergence of resistance, limited drug-related adverse effects, and limited healthcare-acquired infections. In Phase 1 of ASP development (2007-2008), the investigators implemented strict restriction policies (requirement of an infectious disease physician’s approval before any attending physician can prescribe certain antibiotics) as well as supplemental policies. In Phase 2 of development (2008-2009), the investigators stopped using restriction policies and relied only on supplemental policies of antibiotic stewardship, such as having pharmacists review prescriptions every day, giving feedback about antibiotic usage to physicians, facilitating bedside discussion about antibiotic therapy between physician and patient, and implementing the active presence of three ID physicians throughout the hospital for six hours a day.
Comparing antibiotic usage between Phase 1 and Phase 2 of ASP development revealed that some antibiotics were prescribed significantly less in Phase 2, some antibiotics were prescribed more, and some exhibited no change. The antibiotics prescribed more during Phase 2 were mostly given in the ICU in response to multidrug-resistant infections. It seemed that despite implementing both core and supplemental policies of antibiotic stewardship, other factors were capable of worsening and spreading the problem of antibiotic resistance – such as invasive measures and infection prophylaxis under inadequate hygiene standards.
The investigators concluded that infection control is most successful when it integrates vigilant hygiene (to prevent the survival and transfer of resistant bacteria) with individual assessments of a hospital or clinic’s circumstances, which might call for additional measures such as patient isolation and staff cohorting. They also acknowledged that hospitals in developing countries may lack the infrastructure to implement such measures consistently and effectively, and recommended that health authorities in those countries should promote antibiotic stewardship programs and other infection control measures. Look for the full text of Dr. Lopardo’s article and detailed study methods in the Pan-American Journal of Public Health.
Gustavo Lopardo, MD (APUA Argentina President)
Liliana Clara, MD
Gabriel Levy Hara, MD
Updated January 2012