ANTIBIOTIC RESISTANCE: A SILENT BREWING STORM IN UGANDA

ANTIBIOTIC RESISTANCE: A SILENT

BREWING STORM IN UGANDA

Professor Samuel Majalija, BVM MSc PhDAssociate Professor, College of Veterinary

Medicine, Animal Resources and Biosecurity

Makerere UniversityE-mail: [email protected]

Key note address: African-Netherlands exchange on reduction of antibiotic use in

dairy farming Igongo Cultural Centre, 30 March 2015 1

Key issues to discuss

A: Challenges and Drivers B: What is antibiotic resistance?C: How does it occurD: State of antimicrobial use in UgandaE: State of antibiotic resistancein UgandaF: Strategies to reduce antimicrobials use in food animals

Key note address: African-Netherlands exchange on reduction of antibiotic use in dairy farming Igongo

Cultural Centre, 30 March 2015

2

A: Challenges and drivers

Key note address: African-Netherlands exchange on reduction of antibiotic use in dairy

farming Igongo Cultural Centre, 30 March 2015

3

1. Exploding Population & Urbanization :

Insurance strategy for the weak

• ~80million by 2035

• 34 Million people

with 60% below 18

years

• 4.42% Popn annual growth

rate (2010) one of the

highest in the world).

• Fertility rate at 6.2 children

per women, the 2nd highest

in the world. Huge

demographic changes &

declining agricultural

production & productivity in

Africa

4Key note address: African-Netherlands exchange on reduction of antibiotic use in dairy


Key note address: African-Netherlands exchange on reduction of

antibiotic use in dairy farming Igongo Cultural Centre, 30 March 2015 5

2…Surge in Milk and Meat Production

Key note address: African-Netherlands exchange on reduction of antibiotic use in dairy farming

Igongo Cultural Centre, 30 March 2015

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Global milk demand and Milk

Production

Demand

Production


dairy farming Igongo Cultural Centre, 30 March 2015

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8

9



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3: Intensification of cattle farming



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4: Animal diseasesCBPP-Kihaha Foot and mouth Disease: Karusu Tuberculosis

5: Environmental concerns

12Key note address: African-Netherlands exchange on reduction of antibiotic use in dairy farming


Animals

[Domestic

& wild ]

Convergence Model

MICROBIAL RESISTANCE STORM

B: What is antibiotic resistance?


Cultural Centre, 30 March 2015 14

Discovery

Alexander Fleming in 1928

– The first antibiotic -

penicillin - was

discovered in 1928 by

Alexander Fleming.

http://upload.wikimedia.org/wikipedia/commons/8/8a/Faroe_stamp_079_europe_(fleming).jpg

http://upload.wikimedia.org/wikipedia/commons/8/8a/Faroe_stamp_079_europe_(fleming).jpg

Classes of Antibiotics

Sulfonamides

Penicillin

Cephalosporins

Tetracyclines

Macrolides

Ketolides

Quinolones

Streptogramins

Amiinoglycosides

Cyclic Lipopetides

Ability of microbes, such as bacteria, to

grow in the presence of an antibiotic drug

that would normally kill it or limit its growth

DEFINITION: Antimicrobial resistance

How Antibiotic Use on the Farm can lead to

Antibiotic Resistance in Humans

Colonized Animal

Susceptible Human

Slaughter

Meat

Oc

cu

pati

on

al

•Soil

•Ground water

•Surface water

•Air

Possible Routes

Food borne Environmental

Van den Bogaard.

2000. Int J.

Antimicrob

Agents. 14:327

Milk



19

How do bacteria become resistant?



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Alter target site

Bypass pathways Enzymatic inactivation or

modification

Decreased uptake

Penetration

Increased efflux

Antibiotic

How do bacteria become resistant?



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The time may come when penicillin can be

bought by anyone in the shops. Then there is

the danger that the ignorant man may easily

underdose himself and by exposing his

microbes to non-lethal quantities of the drug

make them resistant.

Alexander Fleming: Penicillin Nobel lecture, Dec 11,

1945

D: State of antimicrobial use in Uganda



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Vet Drug Discovery: Costly Venture

Drug: $100 million prior to approval

Vaccine: $80 million (> 4 years)

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Drug Inspection of Good manufacturing practice

Certification and registration of drugs in Uganda

Registration and Certification of pharmacies

/ drug shops at district level

Farmers

Ensure Safe and efficacious drugs for humans and animals

Weak monitoring link

25

BRANDS OF ANTIBIOTICS FOR ANIMALS IN UGANDA

Ugandan Drug Market: Cattle &

Poultry dependent:

Dairy corridor

Poultry

corridor

188 brands of antibiotics on market

27

TETRACYCLINE120 [75%]

GENTAMYCIN 4[3%]

AMPROLIUM4 [3%]

NORFLOXACIN 3 [2%]

PENSTREP-7 [4%]

AMPRO-SUL 7[4%]

NEOM, TET, PENICILLIN

2[1%]

SULFADIAZINE TRIMETHOPRIM

12[8%]

Commonly imported antimicrobial drugs

Key note address: African-Netherlands exchange on reduction of antibiotic use in dairy farming Igongo Cultural Centre, 30

March 2015

28

Class/Brand of

antibiotic

No of

Brands

Class/Brand of

antibiotic No of

Brands

Class/Brand of antibioticNo of

Brands

Gentamycin 4 Flumequine

100mg/Gm2

Ampicillin/

Cloxacillin

1

Amprolium

11

Amprolium/

Sulphaquinoxaline 2

Oxytetracycline/

Flunixin 1Oxytetracycline 120 Oxytetracycline/

Neomycin 2

Cloxacillin/

Benzathine 1Norfloxacin

3

Benzathine/

Procain Penicillin 1

Nitroxynil

1Penstreptomycine 7 Enrofloxacin

2

Ampicillin/

Cloxacilin 1Amprolium

Sulphate 7

Norfloxacin

2

Doxycycline

2Neomycin

Sulphate,

Oxytetracycline &

Procaine Penicillin

2 Amoxicillin

Trihydrate

2

Flunixin

Meglumine

1Ampicillin/

Cloxacillin 1

Colistine Sulphate

2

Neomycin / Penicillin

G

1

Sulfadiazine

Trimethoprim 12

E: State of antibiotic resistancein Uganda



29

I am not blind, if

antibiotic resistance

were a big issue I

would have seen it by

now

Ministry of health

Is antimicrobial resistance a real problems in

pathogens from animals in Uganda

Resistance of Salmonella from cattle

100

8080 80

Irrational Drug Use in Uganda

Abuse of Human drugs in

food animal production

Antibiotic &

Anthelmintic

Resistance

Over prophylaxis

of Animals with

Antibiotics

Challenges Vet Drug in Uganda

Withdrawal Periods

Chemical residues in

Meat

Chemical residues in Milk

Export ruined

Uganda is a

signatory to

WTO, SPS

agreement,

Current Chair

of OIE-Africa

http://blog.makezine.com/meat224.jpg

http://blog.makezine.com/meat224.jpg

http://www.igreenspot.com/wp-content/uploads/milk-glass-light2.jpg

http://www.igreenspot.com/wp-content/uploads/milk-glass-light2.jpg

• Constricted by Production volume

• Comprehensive competition for market

segment

• Active marketing beyond the shop

• Farmer “spoiled” for choice

• Ring fencing clients

• Lack of prescription

Challenges Vet Drug in Uganda

Disciplinary ‘silos’ and

paradigm paralysis.

Traditional disciplinary

approach not working

well enough

System planning and

Implementation

Hu

man

he

alt

h

An

imal h

ealt

h

Pla

nt

healt

h

Eco

syste

m

healt

h

Current disciplinary silos

37Key note address: African-Netherlands exchange on reduction of antibiotic use in dairy farming




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F: STRATEGIES TO REDUCE ANTIMICROBIALS USE IN FOOD ANIMALS

i) Herd health and good management

• Improved husbandry practices

• Standardized protocols for farming

– sanitation on farms

– screening of breeding stock

– genetic selection to enhance disease resistance

Key note address: African-Netherlands exchange on reduction of antibiotic

use in dairy farming Igongo Cultural Centre, 30 March 2015 39

ii) Host resistance and

vaccines• Vaccination programs to prevent many

important bacterial and viral infections of

cattle

• Eg, FMS, CBPP, Blanthrax, Brucellosis


Igongo Cultural Centre, 30 March 2015 40

iii) Biosecurity measures

Revive the common good policies which are

none existent.

• Measures to block introduction and spread of

diseases:

• limiting access to farm sites,

• Visitors to change clothing and boots,

• Control birds and rodents,

• Treating animals with disinfectant foot baths



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iv) Natural remedies

• Use of herbal plants with medicinal

properties.

• These are frequently eaten by our cattle

during grazing. They should be incorporated

into their diets

• Research into production of herbal

remedies



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43

v

vi

vii

viii

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Develop the

evidence for policy

action on antibiotic.

Develop actionable

national strategies to

address the challenge

of antibiotic

resistance.

Collaborate/cooper

ate with like-minded

global and local

initiatives.

Uganda



45

Thank youKey note address: African-Netherlands exchange on reduction of antibiotic use in dairy farming


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Acknowledgments

Documents

ANTIBIOTIC RESISTANCE: A SILENT BREWING STORM IN UGANDA