Antibiotic Resistance in Syria: A Local Problem Turns Into a Global Threat

Abstract

Pharmaceutical sector of Syrian Arab Republic before the war was characterized by bold and successful development since the late 1980s. With the beginning of war in the country back in March 2011, momentum has changed significantly. Traumatism, communicable diseases related to morbidity and mortality as well as wound infections became particularly hot public health concern. This relates not only to the direct victims of military conflict but also to the displaced civilians, refugees, and ordinary citizens alike. Evolving legislative framework in Syria since 1980s tolerated dispensing of antibiotics without appropriate prescription. Such practice led to spreading of antibiotic resistance among the local bacteria frequently causing both community-acquired and nosocomial infections. Laboratory findings of resistant bacteria strains among the Syrian refugees in some European countries serve as evidence of concern spreading far beyond Middle East. Practice of self-diagnosis and self-medication with antibiotics by patients themselves and restraint to pharmacist advice is widespread. A number of recommendations is presented to stakeholders to compact antibiotic resistance after the peace is established in the country. The successful implementation of such recommendations is the way to preserve shrinking golden reserve of highly potent antibiotics as it is the last defense line against resistant bacterial strains causing severe life—threatening infections.

The Evaluation of Antibiotic Consumption at the Inpatient Level in Kazakhstan from 2011 to 2018

“…At the same time, according to the commercial data of another Kazakhstan study, quinolones were the third most consumed antibiotic group, representing from 7.5% to 24.6% of total J01 consumption [8]. Third place was occupied by the group "J01M Quinolone antibacterials" in European Union and European Economic Area (EU/EEA) countries (according to the surveillance report "Antimicrobial Consumption in the EU/EEA") [12]. Concerning the group "J01F Macrolides, lincosamides and streptogramins" on an inpatient level in Kazakhstan, a sustainable reduction in consumption was noted (accounting for 56% and reaching its minimum in 2018 (0.36 DID compared to 0.73 DID in 2011)).…”

Vancomycin-Resistant Enterococci (VRE) in Nigeria: The First Systematic Review and Meta-Analysis

“…This high prevalence could be as a result of various risk factors such as contact with VRE patients, infected animals, surfaces and objects, underlying conditions, serious illness, prior hospitalization, use of catheters, and improper antibiotic usage [ 45 ]. Camins et al [ 46 ] stated that health care contacts were the likely source of VRE colonization and infection, and this is plausible in situations where infection control knowledge, attitudes, and practices among healthcare workers, farmworkers, and the general population are poor in third-world countries [ 47 , 48 , 49 , 50 ] and Nigeria [ 26 ]. The antimicrobial susceptibility testing mainly relied on the disc diffusion method and was interpreted according to the Clinical and Laboratory Standard Institute (CLSI) guideline.…”

Challenges of Global Public Health Emergencies: Development of a Health-Crisis Management Framework

“…Many of the cases were not transported for several hours or days, bringing surgical triage standards and coordination for transportation priority shamelessly close to what was experienced by military casualties in the Napoleonic Wars of the 1800s (Forrester et al 2019). Also, internal conflicts led to the first incidents of antibiotic resistance to wound infections, a crucial problem now impacting all of global health (Jakovljevic et al 2018) Establishing civilian standards of care in war and conflict will require unprecedented and currently unavailable phase-related requirements and opportunities provided by international organizations supported by international humanitarian law and the Geneva Convention.…”