Antibiotic resistance is no longer a threat, it is a clear and present danger requiring concerted actions at a global level. However, Dr Caretta explained that the level of danger varies by geography due to rates of resistance and main causative agents differing between countries. In industrialised countries the primary issue is AMR in hospitals, whereas in less developed countries such as Mexico, the main problem is in community acquired infections.
Giving some context on Mexico, Dr Caretta described it as a middle-income country with a fairly good human development index and representing a significant economy in Latin America. However Mexico has grave challenges regarding social mobility and corruption, with more than 53 million people living in poverty with no access to healthcare systems or education. This presents a difficult environment to develop strategies to address AMR.
One of the main milestones in regulating antibiotic prescriptions in Mexico was the implementation of a policy to prevent pharmacists providing antibiotics to patients without a prescription. In Latin America, Chile was the first country to implement this policy in 1999. In 2005, Colombia partially followed suit by regulating the OTC sales of antibiotics but only in the capital city. Initially the Mexican government was hesitant to initiate a similar policy due to economic reasons. However, after a particularly bad H1N1 influenza epidemic and associated mortality there was an upsurge in pressure to implement new policies.
Consequently in 2010, a policy was implemented that enforced the prohibition of antibiotic sales without prescription. This policy introduced punitive measures against pharmacies and drugstores that sold antibiotics without a prescription and meant they could face losing their business licence. Five years later, a study showed a 34% decrease in the use of antibiotics in private practice in Mexico.
Antibiotic resistance is no longer a threat, it is a clear and present danger
Dr Sergio Caretta
However, the situation in Mexico presents many additional challenges to tackling AMR. In addition to inadequate infrastructure and overcrowding in cities, Mexico has a fragmented healthcare system. There is a private healthcare
system, a public healthcare system and a parallel healthcare system. The parallel system is made by businessmen who buy pharmacies and hire general practitioners to write scripts for people that cannot pay for medical attention. In these facilities, the prescription of antibiotics is often inappropriate, and driven by patient desires instead of physician knowledge and advice.
In order to implement successful policies in Mexico it is important to understand both health and socioeconomic issues. It is also important to work with all stakeholders not only the GPs and specialists, but also with the public. Dr Caretta concluded that the combination of policy change and education initiatives can result in a significant reduction in the inappropriate use of antibiotics as long as HCPs are also given appropriate training and resources to convince patients that they don’t necessarily need antibiotics.