From IMU to Dal, and Beyond: An Interview with Randy Aung

April 19, 2016 Maria Wilson 1 Comment

Dr. Randy Aung, second year MSc. Community Health & Epidemiology student at Dalhousie University.

Dr. Randy Aung, originally from Yangon in Myanmar, is a second year student in the MSc. Community Health and Epidemiology program at Dalhousie University. He is also a member of the Dalhousie Medical School Class of 2014, and began his medical education at the International Medical University (IMU) in Malaysia. During his time as a student at Dalhousie, Randy participated in the Global Health Office Link Program, and acted as an intern at the World Health Organization (WHO). We recently sat down with Randy to learn more about his Dalhousie experience.

What did your internship at WHO this past summer entail, and how did you discover this opportunity?

I was talking to Shawna O’Hearn (the director of the Global Health Office) and she mentioned that there is an opportunity each year for a few Dalhousie students to undertake an internship with WHO. I was interested in building my resume, and she connected me with the organizers. It was an unpaid internship, and although Geneva can be expensive, I think the experience was well worth it. You get to meet so many people from different countries, and also travel on the weekends.

I worked on two main projects with the SAGE (Strategic Advisory Group of Experts) secretariat at the Department of Immunization, Vaccines and Biologicals. The first project involved working with the Wikipedia Medical Director to incorporate all the WHO vaccine recommendations into their respective Wikipedia pages. The other project involved revising the 2015 guideline document for WHO vaccine position papers. For each vaccine-preventable disease, there is a ~30 page position paper where WHO recommendations are published. If a working group needs to prepare a position paper, they have to refer to the guidelines. The whole internship lasted for two and a half months.

Randy and the other 2015 WHO interns in Geneva.

How would you describe your experience at Dalhousie and in Halifax?

Halifax is a cool city. Before I moved, I had only lived in big cities like Singapore and Kuala Lumpur. When I was Googling it, Halifax seemed to be pretty small…but when I arrived here, I found that there are so many things to do. I really love the snow in the winter, as ridiculous as it may sound! Before I moved I had never seen snow.

The people here are really friendly, especially at Dal. When I was in medical school, everyone was very willing to help and reach out so you can succeed in your career and academic goals. For medical school, Halifax was a big change from Malaysia where I did the first part of my medical school. Malaysia has a completely different healthcare system compared to Canada. During my first clinical rotation, it took a while to get used to these changes. Once I got into my second rotation though, I was more familiar with how things worked in the hospital. I decided to do a Master’s in Community Health & Epidemiology (CH&E) because I didn’t have any undergraduate degree before medical school and I had no previous research experience. Evidence-based medicine is very important. Research studies come out so fast, and there are so many of them. You have to be able to critically appraise which studies are of good quality, and which ones are relevant to the patients you are seeing. CH&E really helped me out with that, and taught me how to appreciate good research.

What are your next steps, now that you are graduating from your Master’s?

I’m moving to New York. I’ll be doing my residency at Bronx Lebanon Hospital Center, which is affiliated with Albert Einstein College of Medicine. My residency in general pediatrics will last 3 years. I haven’t made up my mind on which sub-specialty I want to go into. I may end up staying with general pediatrics, but I am considering pediatric hematology/oncology or pediatric infectious diseases for my fellowship.

What type of research are you conducting for your CH&E Master’s thesis?

I’m working with Dr. Joanne Langley at the Canadian Center for Vaccinology. We are conducting a retrospective cohort study, looking at the incidence and clinical burden of lower respiratory tract infections in immunocompromised children. This involves a retrospective chart review.

Why are you interested in pediatrics?

First of all, I love kids and I love working with kids. You get to work and play at the same time, which is a great career! I find that kids are very resilient, and they really tend to improve after seeing doctors. This is different from some other specialties. Take older adults who present at an Emergency Department with heart failure or COPD. They get treated, but it can often be a cycle [in older patients], where it is difficult to see improvement. But for kids, they often get better, and that’s one of the main things that I love about pediatrics. You can make a very visible difference.

Could you tell us a bit about the Link program, and how it helped you to transition into your clerkship?

The Link program lasts about 3 months (15 weeks) and is designed by the Global Health Office for IMU students. We study for two and half years in Malaysia, then we transfer for third and fourth year at Dalhousie Medical School. The curriculum at IMU versus Dal are a bit different. There are some aspects that are not covered in Malaysia, such as psychiatry and pediatrics. We also didn’t have a lot of clinical experience in our first two years at IMU, whereas at Dalhousie during these years they have clinical experience weekly. The Link program is basically a transition period, where topics like psychiatry and pediatrics are covered, and we get to experience a four-week hospital rotation. We shadow doctors, like Dalhousie students do in the first two years of their medical education. It was a good transition, I couldn’t imagine myself going straight into third year without the Link program. I wouldn’t know what to do! The program also included an introduction to the Canadian healthcare system.

Do you have any advice for incoming IMU students?

One important thing to note is that there is only one province where you can do your residency in Canada after this program – Newfoundland. I would advise IMU students to take the United States Medical Licensing Examination (USMLE) before coming to Dalhousie if you’re interested in doing residency in the US. Clerkship can be busy, and you might not have as much time to study for, and take that exam during this time.

Note: Randy took a break between graduating from medical school and residency, and wrote the exam while studying for his Master’s degree.

Try to be outgoing, and enjoy what Halifax has to offer. The university culture is a bit different. In Malaysia, you don’t usually ask questions when you are face to face with your staff physicians. In Halifax, you are encouraged to talk and ask questions. Even if you don’t know all the answers, don’t be afraid to try and put yourself out there. It will help you grow and learn.

To learn more about the IMU partnership, please watch the Faculty of Medicine’s latest Youtube video (which features Randy at 3:27)!

Randy and friends during summer travels in Interlaken.

World Tuberculosis Day Part III – Treatment & Drug Resistance

March 8, 2016 Maria Wilson Leave a Comment

The World Health Organization (WHO) has declared March 24, 2016 as World Tuberculosis (TB) Day [1]. Over the month of March, the Global Health Office will be publishing a series of blog posts about TB in hopes of raising awareness of its worldwide impact. WHO’s “End TB Strategy” has a goal of ending the TB epidemic by 2030, by targeting poverty, improving testing and treatment, ending stigma and discrimination, and driving research and innovation. Put simply, TB is not yet a disease of the past, but if we unite and focus our efforts, we can make TB history.

Last week we talked about diagnosing TB, and the importance of determining an appropriate treatment course along with that diagnosis. But how is TB treated, and why is drug resistance an issue with TB in particular?

Although those with latent TB infection do not present symptoms, and cannot spread TB bacteria to others, treatment can still be provided to stop them from developing TB disease. This step is important in eliminating and controlling TB around the world, but should only be initiated once the possibility of TB disease has been excluded. In the United States, four treatment regimens are approved, using combinations of isoniazid, rifampicin and rifapentine. Treatment for latent TB can last anywhere from 3 months to 9 months, necessitating between 12 and 270 doses (minimum) of anti-TB drugs [2].

Treating those with active TB disease is a much more pressing matter, as they have the potential to spread the disease to others. Treatment regimens for active TB disease can last between 6 and 30 months depending on resistance, a process which burdens patients and treatment providers alike [3]. With a treatment course this long, some patients inevitably fail to complete the full regimen, for many reasons including finances, social pressures and inadequate access to proper treatment. To provide a glimpse at the financial burden of TB, each case in Canada cost the healthcare system $47,290 [4]. This can lead to acquired drug resistance, which can then be passed on to others when the infected person, coughs, sneezes or spits, releasing TB bacteria into the air [5].

There are two types of drug-resistant TB: multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB). MDR-TB bacteria does not respond to (at least) the two most widely used and powerful first line TB drugs: isoniazid and rifampicin [6]. XDR-TB involves resistance to isoniazid and rifampicin, in addition to resistance to any of the fluoroquinolones (ofloxacin, etc.), and to at least one of three injectable second-line drugs (amikacin, capreomycin or kanamycin) [7]. Both MDR-TB and XDR-TB take longer than regular TB to treat (at least 18 months) and have lower treatment success rates. Furthermore, patients often experience more harsh side effects from treatment, leading to increased hospitalization [8]. In order to maximize the potential for positive treatment outcomes, it is important that further tests are undertaken after initial diagnosis to determine whether bacteria is drug-resistant, and provide appropriate treatment [7].

According to the WHO Global TB Report, in 2014 an estimated 3.3% of new TB cases and 20% of previously treated cases had MDR-TB. More than half of these cases occur in India, China and the Russian Federation. Additionally, an estimated 190,000 people died of MDR-TB in 2014. As of 2015, XDR-TB had been reported in 105 countries. The map below shows the number of patients in these countries with laboratory-confirmed XDR-TB who started treatment in 2014 [9].

Map of the world, showing the number of laboratory-confirmed cases of XDR-TB receiving treatment by country, 2014. (Source: World Health Organization).

In response to treatment non-adherence, and to combat the spread of drug-resistant TB, the directly observed therapy, short-course (DOTS) strategy was developed by WHO in 1994. Health workers meet with patients regularly to help with treatment, adherence, and to provide support and education. This strategy also advocates for increased allocation of domestic and international funding and resources to combat TB [10]. Tuberculosis is also highlighted in two recent worldwide strategies, the WHO End TB Strategy, and the UN Sustainable Development Goals (SDGs), which will be discussed in our next post.

World Tuberculosis Day Part II – Tuberculosis Testing and Diagnosis

March 2, 2016 Maria Wilson Leave a Comment

Mycobacterium tuberculosis scanning electron micrograph. Mag 15549X. Source: CDC.

Now that you have an idea of how TB is spread, its symptoms and its worldwide burden, let’s talk about how TB is diagnosed.

When a patient presents with the symptoms discussed in the last blog post (coughing up blood, cough lasting longer than 3 weeks, unexplained weight loss, etc.), a medical history is taken to determine whether TB infection is probable. Questions that are asked include whether they have been in close contact with someone with TB, if they have a previous history of TB infection, and whether they have an immunocompromising condition (such as HIV) that could increase the risk of latent TB infection progressing to TB disease [2].

There are two primary types of tests that are used to determine if a patient has been infected with TB bacteria: the tuberculin skin test and TB blood tests. The tuberculin skin test (also called the Mantoux tuberculin skin test) involves injecting a small amount of fluid (tuberculin) into the skin of the lower arm. After 48-72 hours have passed, a trained health care worker will look for a raised, hard area or swelling, to determine whether infection is present. TB blood tests (interferon-gamma release assays or IGRAs) measure how a person’s immune system reacts to TB bacteria by testing a blood sample in the laboratory. Blood tests are preferred for those who have had a TB disease vaccine, or who would have difficulty returning for a second appointment. Testing positive on either of these tests does not differentiate between latent TB infection and TB disease, it simply means the person’s body is infected with TB bacteria [3].

Diagnosing active TB involves a series of other tests. Chest X-rays can be used to check for lung abnormalities, but X-rays alone cannot provide a definitive TB disease diagnosis. Sputum Smear Microscopy (SSM) is one of the techniques used to diagnose active TB. Sputum is examined under a microscope for Mycobacterium tuberculosis. SSM can provide results in 24 hours, but it cannot always distinguish between TB and other infections. Polymerase Chain Reaction (PCR) testing can be used to detect genetic material specific to TB in bacteria; however, this test is complicated and can be much more expensive than SSM. Diagnosing TB outside of the lungs can include tests such as a biopsy, lumbar puncture, urine culture or CT scan [4].

Culture techniques, where TB bacteria can be grown in a laboratory from a variety of specimens, are also used to diagnose active TB, though it can take 1-6 weeks to obtain results. Culture techniques are particularly useful in determining an antibiotic treatment course, an important step in combatting TB. One of the largest issues in TB treatment is properly identifying and targeting drug resistance in order to provide appropriate treatment, a topic that will be discussed in our next post [5].

World Tuberculosis Day Part I – What is TB?

March 1, 2016 Maria Wilson Leave a Comment

Tuberculosis (TB), caused by the bacillus Mycobacterium tuberculosis, is an airborne disease that primarily affects the lungs (pulmonary TB) [2]. This means that when people with pulmonary TB cough, sneeze or spit, TB bacteria are propelled into the air, giving them the potential to spread from person to person via inhalation. TB can affect other sites as well, including the brain, the kidneys and the bones [3]. An ancient disease, TB has affected humans for over 4,000 years [2].

In many cases, the immune system will fight off the TB bacteria, and no infection occurs. If the immune system is not able to completely fight off the bacteria, some inactive bacteria may stay in the body, leading to latent TB infection (no symptoms). If the immune system does not respond sufficiently, active TB infection occurs (TB disease), and symptoms begin to manifest [4]. People with latent TB infection cannot spread TB bacteria to others, but can go on to develop active TB over time. WHO estimates that about one-third of the world’s population is infected with latent TB [5]. Symptoms of TB disease include a persistent cough of 3 weeks or longer, pain in the chest, coughing up blood or sputum, weakness or fatigue, weight loss, loss of appetite, chills, fever and night sweats [6].

The burden of TB is mainly concentrated in low and middle income countries, where 95% of TB deaths occur. In 2014, there were 1.5 million TB deaths, and 9.6 million people developed TB disease [5]. TB is one of the leading causes of deaths from infectious diseases worldwide [7]. The map below, produced by WHO, shows estimated TB incidence rates, by country, in 2014.

Map of the world showing estimated TB incidence rates, by country, in 2014 (Source: World Health Organization).

This map provides a visual representation of the worldwide burden of TB, with the lowest rates in Western Europe, Canada, the United States of America, Australia and New Zealand. This has led to a common misperception in higher income countries that TB is a disease of the past. However, in many countries, including Lesotho, South Africa, Swaziland and Mozambique, rates are still above 500 cases per 100,000 population [7].

Keep reading our series of blog posts on TB to learn more about risk factors, diagnosis, treatment and much more.

Current Topics in Global Health: Zika Virus (Part II)

February 24, 2016 Maria Wilson Leave a Comment

Depiction of microcephaly. Source: Javier Zarracina/Vox.

Part I of our current topics post on Zika virus examined the origin and spread of Zika virus, as well as its potential link to microcephaly and GBS. The timing seems to make sense, but WHO estimates it could take four to six months to determine whether these associations are causal. The virus has been found in the tissues of several infants who died from microcephaly, and efforts are underway to study mothers who have reported symptoms, or had a confirmed case, of the virus during their pregnancies [1].

Between January 1 2007 and February 17 2016, a total of 48 countries and territories reported local transmission of Zika virus. This includes countries where the outbreak has been deemed over, with the latest cases reported in Aruba and Bonaire [2]. The Public Health Agency of Canada (PHAC) has confirmed travel-related cases of Zika virus from Central and South America, and from the Caribbean. However, the Aedes mosquito vector is not present in Canada due to our climate. Although the overall risk to travellers is low, PHAC advises pregnant women or those considering becoming pregnant to consider postponing travel to these regions. If postponing is not an option, PHAC recommends these groups take all possible measures to prevent being bitten by mosquitos [3]. These measures include wearing long sleeves and long pants, using insecticide-treated mosquito nets (especially if sleeping during the day when the Aedes mosquito is most active), and using insect repellents. It has also been recommended that men with a pregnant partner who reside in, or have travelled to, these areas use condoms consistently and correctly [4]. Eliminating possible mosquito breeding sites is also recommended, such as areas where rain collects, and where water is stored outside [5].

It is likely that once a person has been infected with Zika virus, they will be protected from future infections. There is no specific medicine to treat, or vaccine to prevent Zika virus. Symptoms are treated with rest, drinking plenty of fluids to prevent dehydration and taking mild pain and fever relief medicine (i.e. acetaminophen). It is recommended that those with Zika virus also take extra measures to prevent being bitten by mosquitos during the first week of infection, in order to halt further transmission [6].

Zika virus has prompted international discussions around disability and reproductive rights. El Salvador has recommended that women do not get pregnant until 2018 [7]. The Pope has suggested that artificial contraception may be morally acceptable in the fight against the Zika virus and its associated microcephaly. Abortion laws are being re-examined in Brazil and other Latin American countries where Zika virus is prominent [8]. Various disability rights groups are lobbying for increased support for women who have babies with microcephaly [9]. Further concerns have been raised as the 2016 Summer Olympics are set to kick off in Rio de Janeiro on August 5. One of the biggest sporting events in the world, the Olympics sure to draw travellers for all over the globe. Brazilian officials are dramatically increasing mosquito eradication efforts, but what impact will Zika have on this gathering of nations [6]?

One thing is certain: the Zika virus is going to be a global health issue to watch in 2016.

World Antibiotic Awareness Week – what are the reasons for and implications of antibiotic resistance? Part 2

November 17, 2015 Maria Wilson Leave a Comment

By: Maria Wilson

Global Health Office Outreach Assistant

This week, the Global Health Office blog is going to get real scientific. So scientific, in fact, that I feel like I’m writing a paper for class (there are even references). It’s also approximately ¼ the length of the average chapter in Harry Potter and the Philosopher’s Stone (I find a way to connect Harry Potter to most things in my life) (1). Due to the length, I have decided to post this information in two installments, here is part 2. Don’t let any of that deter you from continuing to read, because the subject matter covered in this post is very important!

Superbug – the latest hero from Krypton?

A term that has been used recently in the media is “superbug” – but what does it mean? Superbugs are bacteria that have become resistant to several antibiotics used in their treatment (11). A prime example of a superbug is Staphylococcus aureus, which has shown resistance to a number of antibiotics including rifampin, ciprofloxacin, tetracycline and β-lactams (11). You may have heard of methicillin-resistant Staphylococcus aureus or MRSA. This strain of bacteria is most often associated with hospital-acquired infections. The incidence of MRSA in Canadian hospitals alone increased 17-fold between 1995 and 2006 (12). Infection control practices can help reduce the spread of MRSA; however, treatment upon infection can be difficult.

What are the impacts of antibiotic resistance?

Antibiotic-resistant strains of bacteria can lead to longer hospitalizations, longer treatment regimens and increased side-effects from the use of multiple and more powerful medications. This places an enormous burden on healthcare systems, using significant human and economic resources (13). The direct economic costs in Canada are estimated at $1 billion annually (12). Antibiotic resistant bacteria are responsible for approximately 25,000 deaths in Europe, 23,000 in the USA, and 8,500-12,000 in Canada annually (12,14). Estimates are less readily available for low-middle income countries, but Laximnarayan et al. assume that antibiotic resistance may have an even greater burden in these areas due to a lack of antibiotic regulation and increased burden of infectious disease (14).

What can I do?

So, what can you, as a member of the general public, do to help?

First of all, and you’ve been told this since you were in kindergarten, WASH YOUR HANDS. Hand-washing prevents infections from spreading in the first place, which in turn should decrease the amount of antibiotics that need to be prescribed. Never share antibiotics with others, or use left-over antibiotics. Left-over or shared antibiotics may not be as effective against the particular bacterial infection your body is trying to fend off. Take your full prescription in order to avoid having to repeat treatment (15). These all seem like simple things, but they really can make a difference!

Hope you enjoyed that essay of a blog post. As always, check out our Facebook, Twitter, Instagram and Website for information on what we here at the Global Health Office do, and all of our exciting upcoming events!

References:

(1) Better Novel Project. Playing the Numbers: Basic Word Counts. 2013. Available from: http://www.betternovelproject.com/blog/word-counts/.

(2) World Health Organization. World Antibiotic Awareness Week. 2015. Available from: http://www.who.int/mediacentre/events/2015/world-antibiotic-awareness-week/event/en/.

(3) World Health Organization. Quiz: How much do you know about antibiotic resistance? 2015. Available from: http://who.int/mediacentre/events/2015/world-antibiotic-awareness-week/quiz/en/.

(4) McDonell Norms Group. Antibiotic overuse: the influence of social norms. J Am Coll Surg 2008;207(2):265-275.

(5) Gandra S, Barter DM, Laxminarayan R. Economic burden of antibiotic resistance: how much do we really know? Clin Microbiol Infec 2014;20(1):973-980.

(6) Scott G. Antibiotic resistance. Medicine 2009;37(10):551-556.

(7) World Health Organization. Antibiotic Resistance: Multi-Country Public Awareness Survey. 2015. Available from: http://apps.who.int/iris/bitstream/10665/194460/1/9789241509817_eng.pdf?ua=1

(8) MeMed. The Resistant Bacteria Problem. 2015. Available from: http://www.me-med.com/html5/?_id=11489&did=2466&g=11051&title=the%20resistant%20bacteria%20problem.

(9) Marshall BM, Levy SB. Food animals and antimicrobials: impacts on human health. Clin Microbiol Rev 2011;24(4):718-733.

(10) Knobler SL, Lemon SM, Najafi M, Burroughs T. The Resistance Phenomenon in Microbes and Infectious Disease Vectors: Implications for Human Health and Strategies for Contrainment – Workshop Summary. The National Academic Press. 2003.

(11) Canadian Antimicrobial Resistance Alliance. Comprehensive Overview of Antibiotic Resistance in Canada. 2007. Available from: http://www.can-r.com/mediaResources/ComprehensiveOverview.pdf.

(12) Canadian Union of Public Employees. Healthcare Associated Infections: A Backgrounder. 2009. Available from: http://cupe.ca/sites/cupe/files/healthcare-associated-infections-cupe-backgrounder.pdf.

(13) Health Canada. Impacts of Antibiotic Resistance. 2014. Available from: http://healthycanadians.gc.ca/drugs-products-medicaments-produits/buying-using-achat-utilisation/antibiotic-resistance-antibiotique/impacts-repercussions-eng.php.

(14) Laxminarayan R, Duse A, Wattal C, Zaidi AKM, Wertheim HFL, Sumpradt N, Vlieghe E, et al. Antibiotic resistance – the need for global solutions. Lancet Infect Dis 2013;13(12):1057-1098.

(15) World Health Organization. Antibiotic Resistance: Fact Sheet. 2015. Available from: http://www.who.int/mediacentre/factsheets/antibiotic-resistance/en/.

World Antibiotic Awareness Week – what are the reasons for and implications of antibiotic resistance? Part 1

November 17, 2015 Maria Wilson Leave a Comment

By: Maria Wilson

Global Health Office Outreach Assistant

This week, the Global Health Office blog is going to get real scientific. So scientific, in fact, that I feel like I’m writing a paper for class (there are even references). It’s also approximately ¼ the length of the average chapter in Harry Potter and the Philosopher’s Stone (I find a way to connect Harry Potter to most things in my life) (1). Due to the length, I have decided to post this information in two installments, here is part 1. Don’t let any of that deter you from continuing to read, because the subject matter covered in this post is very important!

WHO Antibiotic Awareness Week

Monday November 16^th marked the first day of the very first WHO Antibiotic Awareness week, which continues until November 22^nd. This is part of a global action plan to address the growing problem of antibiotic resistance devised at the World Health Assembly in May 2015 through education, communication and training (2). Want to test your knowledge before reading the rest of this post? WHO has put together a quick, 6-question online quiz that touches on the basics of antibiotic resistance, which you can find here (3).

How did you do?

If you got less than 6/6, good effort! But, you should keep reading because there is some useful information contained in this post that will help you get a perfect score in future. If you got 6/6 – congratulations! However, you should also keep reading because there is plenty of information not covered in the quiz that we have included here (also because it took me most of the work day to write this).

What are antibiotics, and how does antibiotic resistance occur and spread?

Antibiotics are used to treat bacterial infections (i.e. urinary tract infections, pneumonia, etc.). They are essentially useless against viral infections (i.e. influenza) or fungal infections (i.e. ringworm). It is important to understand that the bacteria, not humans or animals, become resistant to antibiotics (4). Antibiotic resistance occurs when bacteria evolve, adapt and become resistant to the effects of antibiotics used to treat the infections they cause. This can happen through (a) genetic mutation or (b) acquiring resistance from another bacterium. Genetic mutation is a natural, spontaneous process (occurring at a rate of 10^-6 to 10^-9, depending on the bacteria); however, misuse and overuse of antibiotics in humans and livestock is only accelerating its course (5,6).

For example, a survey conducted by WHO found that of 9,772 respondents from 12 countries, 32% thought they should stop taking antibiotics once they felt better, even if they had not yet completed the full course of treatment (7). Shortening the recommended treatment regimen may not kill all of the infection-causing bacteria, which can lead to the need to re-initiate treatment later. Overusing antibiotics kills susceptible bacteria, but selectively allows more resilient, antibiotic-resistant bacteria to survive and multiply in an environment with less competition. This process is called selective pressure, and is depicted in the infographic below (8).

Antibiotic-resistant bacteria can go on to spread from person to person through direct contact, or contact with a surface that has touched a person with an antibiotic-resistant infection. Furthermore, resistant bacteria can be spread from livestock, food or water to humans, due to the extensive use of antibiotics in the agricultural industry. Low-dose application of antibiotics in a large number of animals augments the “selection density” of the antibiotic (9). This means that even though resistance occurs naturally at a certain rate, using more and more antibiotics can shorten the amount of overall time it takes for drug resistant bacteria to appear. This is very similar to antibiotic overuse in humans, except for the fact that in livestock, antibiotics are not always used therapeutically to treat disease. Antibiotics are also used for a wide variety of nontherapeutic purposes including growth promotion, contributing significantly to resistance (9).

A number of other factors are contributing to the growing antibiotic resistance, including: overprescription, access to antibiotics without a prescription and poor hygiene and infection control practices (10). Antibiotic resistance represents one of the largest threats to global health today, as it can affect anyone, of any age, in any country (7). The lack of effective new antibiotics being developed also worsens the problem, as we are quickly running out of alternative treatment courses for a number of drug-resistant bacteria (10).

Archives for who