Cada mes de noviembre se celebra la Semana Mundial de Concientización sobre el Uso de los Antibióticos. La misma tiene como objetivo generar conciencia sobre la importancia del uso adecuado de los medicamentos en la lucha contra la resistencia a los antibióticos. Este año, transcurre entre los días 12 y el 18 de noviembre bajo el lema:
“Nuestro tiempo con antibióticos se está acabando. El cambio no puede esperar”.
Desde su descubrimiento, los antibióticos han sido la piedra angular de la medicina moderna. Sin embargo, el abuso y el uso indebido persistentes de los antibióticos en los humanos y los animales han facilitado la aparición y propagación de resistencias, con lo que los fármacos utilizados para tratar las infecciones dejan de ser eficaces.
La Semana Mundial de Concientización sobre el Uso de los Antibióticos es un esfuerzo que intenta comprometer a todos los sectores involucrados en esta lucha.
La resistencia a los antibióticos es hoy una de las mayores amenazas para la salud mundial, la seguridad alimentaria y el desarrollo.
La resistencia a los antibióticos puede afectar a cualquier persona, sea cual sea su edad o el país en el que viva.
La resistencia a los antibióticos es un fenómeno natural, aunque el uso indebido de estos fármacos en el ser humano y los animales está acelerando el proceso.
Cada vez es mayor el número de infecciones —por ejemplo, neumonía, tuberculosis, gonorrea y salmonelosis— cuyo tratamiento se vuelve más difícil debido a la pérdida de eficacia de los antibióticos.
La resistencia a los antibióticos prolonga las estancias hospitalarias, incrementa los costos médicos y aumenta la mortalidad.
LA RESISTENCIA A LOS ANTIMICROBIANOS Y LAS INFECCIONES
La resistencia a los antimicrobianos pone en peligro la eficacia de la prevención y el tratamiento de una serie cada vez mayor de infecciones por virus, bacterias, hongos y parásitos.
La resistencia a los antimicrobianos se produce cuando los microorganismos (bacterias, hongos, virus y parásitos) sufren cambios al verse expuestos a estos (antibióticos, antifúngicos, antivíricos, antipalúdicos o antihelmínticos, por ejemplo), como resultado, los medicamentos se vuelven ineficaces y las infecciones persisten en las personas, lo que incrementa el riesgo de propagación a otras.
Infecciones adquiridas en la comunidad
Las resistencias impactan en el tratamiento de las infecciones adquiridas en la comunidad; como ejemplo, las infecciones urinarias por Escherichia coli o las infecciones respiratorias por Streptococcus pneumoniae o Haemophilus influenzae pueden no responder a los antibióticos empleados de rutina y requieren la utilización de tratamientos más complejos y de mayor costo.
Infecciones adquiridas en los hospitales
Los patógenos multirresistentes son responsables de un aumento en la morbi mortalidad de los pacientes ingresados en los hospitales, y ocasionan gran aumento en los costos de salud por la prescripción de medicamentos más caros y la prolongada estancia hospitalaria. Estas infecciones hospitalarias afectan a los pacientes más frágiles, en las unidades de cuidados intensivos, oncología, neonatología, donde suelen ocasionar una alta mortalidad.
Contención de la resistencia
Las acciones principales para contribuir a la contención de la resistencia a los antimicrobianos son: la prescripción adecuada, la educación comunitaria, la vigilancia de la resistencia y de las infecciones asociadas a la atención en salud y el cumplimiento de la legislación sobre uso y dispensación de antimicrobianos.
La Secretaría de Salud de Argentina, se encuentra trabajando activamente con otras secretarías y ministerios (OIE: organización mundial de la salud animal; SENASA: El Servicio Nacional de Sanidad y Calidad Agroalimentaria; FAO Organización de las Naciones Unidas para la Agricultura y la Alimentación. INTA: Instituto Nacional de Tecnología Agropecuaria dependiente del Ministerio de Agroindustria de la Nación y Ambiente y desarrollo sustentable) y sociedades científicas, (Asociación Argentina de Enfermeros en Control de Infecciones- ADECI; Sociedad Argentina de Infectología – SADI; Sociedad Argentina de Terapia Intensiva – SATI; Sociedad Argentina de Infectología Pediátrica – SADIP; Asociación Argentina de Microbiología-AAM) a los efectos de desarrollar programas en conjunto para contener la resistencia antimicrobiana
La red de vigilancia de Argentina está constituida por 89 centros distribuidos por todo el país. El laboratorio coordinador de la red de vigilancia de la resistencia a los antibióticos es el Instituto Nacional de Enfermedades Infecciosas ANLIS “Dr. Carlos G. Malbrán”.
Para prevenir y controlar la propagación de la resistencia a los antibióticos:
La población general puede:
- Tomar antibióticos únicamente cuando los prescriba un profesional sanitario certificado.
- No pedir antibióticos si los profesionales sanitarios dicen que no son necesarios.
- Seguir siempre las instrucciones de los profesionales sanitarios con respecto al uso de los antibióticos.
- No utilizar los antibióticos que le hayan sobrado a otros.
- Prevenir las infecciones lavándose frecuentemente las manos, preparando los alimentos en condiciones higiénicas, evitando el contacto cercano con enfermos, adoptando medidas de protección en las relaciones sexuales y manteniendo las vacunaciones al día.
- Preparar los alimentos en condiciones higiénicas tomando como modelo las cinco claves para la inocuidad de los alimentos de la OMS (mantener la limpieza; separar alimentos crudos y cocinados; cocinar completamente; mantener los alimentos a temperaturas seguras; y usar agua y materias primas inocuas), así como elegir alimentos para cuya producción no se hayan utilizado antibióticos con el fin de estimular el crecimiento ni de prevenir enfermedades en animales sanos.
Los planificadores de políticas pueden:
- Poner en práctica planes nacionales de acción para hacer frente a la resistencia a los antibióticos.
- Mejorar la vigilancia de las infecciones resistentes a los antibióticos.
- Reforzar las políticas, los programas y la aplicación de las medidas de prevención y control de las infecciones.
- Reglamentar y fomentar el uso y la eliminación apropiada de medicamentos de calidad garantizada.
- Informar sobre el impacto de la resistencia a los antibióticos.
Los profesionales de la salud pueden:
- Evitar las infecciones velando por la limpieza de las manos, el instrumental y el entorno.
- Prescribir y dispensar antibióticos solo cuando sean necesarios, de conformidad con las directrices en vigor.
- Notificar las infecciones resistentes a los antibióticos a los equipos de vigilancia.
- Informar a los pacientes sobre cómo tomar los antibióticos correctamente, la resistencia a estos fármacos y los peligros de su uso indebido.
- Informar a los pacientes sobre cómo se pueden prevenir las infecciones (por ejemplo, vacunándose, lavándose las manos, velando por la seguridad de las relaciones sexuales o cubriéndose la boca y la nariz al estornudar).
- Procurar no recetar antibióticos a menos que sean realmente necesarios, conocer los patrones de sensibilidad locales y trabajar intensamente en la prevención de infecciones.
El sector de la salud puede:
- Invertir en la investigación y desarrollo de nuevos antibióticos, vacunas, productos diagnósticos y otros instrumentos.
- Las autoridades en salud deben asumir su responsabilidad y ser líderes en el desarrollo de planes de acción para hacer frente a la problemática de la resistencia a los antibióticos convocando a todos los sectores involucrados
El sector agrícola puede:
- Administrar antibióticos a los animales únicamente bajo supervisión veterinaria.
- No utilizar antibióticos para estimular el crecimiento ni para prevenir enfermedades en animales sanos.
- Vacunar a los animales para reducir la necesidad de antibióticos y utilizar alternativas a estos siempre que las haya.
- Fomentar y aplicar buenas prácticas en todos los eslabones de la producción de alimentos de origen animal y vegetal.
- Fomentar la seguridad biológica en las granjas para prevenir las infecciones mediante la mejora de la higiene y el bienestar de los animales.
La Organización Mundial de la Salud
El tema de la resistencia antimicrobiana es de preocupación en todo el mundo, a tal punto que figura en la agenda de la reunión del G-20. La Organización Mundial de la Salud ha propuesto un plan de acción que incluye cinco puntos centrales:
- mejorar la sensibilización y los conocimientos en materia de resistencia a los antimicrobianos;
- reforzar la vigilancia y la investigación;
- reducir la incidencia de las infecciones;
- optimizar el uso de medicamentos antimicrobianos;
- y asegurar que se realicen inversiones sostenibles en la lucha contra la resistencia a los antimicrobianos.
Fuentes:
– Organización Mundial de la Salud (http://www.who.int/es/news-room/fact-sheets/detail/resistencia-a-los-antibi%C3%B3ticos)
– Revista de Patología tropical (https://www.paho.org/hq/dmdocuments/2017/2014-cha-informe-anual-relavra.pdf)
– Sociedad Argentina de Infectología (https://sadi.org.ar/novedades/item/678-atencion-se-viene-la-semana-de-concientizacion-sobre-el-uso-de-antibioticos)
– Organización Panamericana de la Salud (https://www.paho.org/hq/index.php?option=com_content&view=article&id=11129:amr-antimicrobial-resistance-intro&Itemid=41534&lang=es)
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