Antibiotic abuse in Latin America: a silent epidemic

In mid-2023, an 80-year-old man was admitted to the emergency department of a Buenos Aires hospital due to infectious psychosis. “I was delirious; “He was so out of his mind that we had to give him a sedative in order to be able to examine him,” he recalled in an interview with the publication SciDev.Net Inier Hinestroza, one of the doctors who treated him.

Bacteria are responsible Klebsiella pneumonia settled in his bladder. For five days, the patient did not improve on the antibiotics he was prescribed to take at home, and the fever began to wreak havoc on his body, whose immune system had been suppressed by the cancer he had suffered in the past.

A laboratory test of the blood samples, called a blood culture, revealed the presence of a dangerous strain known as KPC. “We call it a superbug,” says Hinestroza, “because it Klebsiella pneumonia resistant to almost all first-, third- and even fourth-line antibiotics.”

The emergence and latent spread of these types of microbes may have been exacerbated by what the World Health Organization (WHO) has called the “excessive and widespread use” of these drugs worldwide during the COVID-19 viral pandemic. 75 percent of those hospitalized received antibiotics, although only 8 percent required them due to bacterial coinfections, as detailed in a recent statement.

The results are based on data from the WHO Global Clinical Platform for COVID-19, an anonymous repository of clinical data that collected information from approximately 450,000 patients admitted to hospitals with COVID-19 in 65 countries between January 2020 and March 2020.

Similarly, the WHO has warned that antibiotics with a high likelihood of developing resistance, such as azithromycin or ceftriaxone, are most often prescribed. Because these drugs do not work against viruses, giving them “if they were helpful” not only did not benefit the clinical development of patients, but there were cases where it was associated with a 20-fold increase in the risk of death.

“The public should be made aware that most gastrointestinal and respiratory infections are viral. If they use antibiotics in these cases, the only thing they will do is create colonies of resistant bacteria in their bodies.”

Patricia Cornejo Juarez, President of the Mexican Association of Infectology and Clinical Microbiology

“This data teaches us several lessons. The most important thing is that starting antibiotic treatment blindly is useless. There are now better diagnostic methods, and if the bacteria are not growing or we are not documenting them with these tools, then the use of antibiotics is not justified,” he warned. SciDev.Net Patricia Cornejo Juarez, President of the Mexican Association of Infectology and Clinical Microbiology.

Adequate use of antibiotics in Latin America faces several challenges. In a survey conducted in 42 hospitals in Guatemala, Panama, Ecuador, Colombia and Argentina, 51 percent of health care workers reported a lack of access to tests to detect resistant infections. Additionally, 22 percent of antibiotic prescribers admitted to not receiving training on how to select antibiotics based on culture results (see infographic).

Another problem in the region is self-medication with antibiotics, which, according to a recent review that analyzed articles published between 2019 and 2023 in English, Spanish and Portuguese; It ranges from 14 to 80 percent, depending on each country. In Peru, according to this study, 80 percent of self-medication was registered, in Colombia – from 24 to 47 percent, in Brazil – from 24.6 to 53.8 percent and others.

Similarly, another study conducted by Oxford University in 35 Latin American countries found that at least 569,000 deaths in 2019 were attributed to bacterial antimicrobial resistance (AMR). The top five countries with the highest mortality rates were Haiti, Bolivia, Guatemala, Guyana and Honduras.

Sonia Urrutia, for example, learned from her mother to use them herself when faced with the slightest discomfort: “It’s something super reckless,” she said. SciDev.Net from Santiago de Chile. “Obviously I never taught my kids the same thing because I had consequences,” he added.

This 52-year-old woman has been suffering from multidrug-resistant infections for just over a decade. The latest occurred in January 2024, when a culture of his urine revealed bacteria that were resistant to an entire family of antibiotics, the beta-lactams. Urrutia was hospitalized for seven days at the Santa Maria Clinic, where only intravenous treatment was available.

“The public should be made aware that most gastrointestinal and respiratory infections are viral. If they use antibiotics in these cases, the only thing they will do is create colonies of resistant bacteria in their bodies, which can be transmitted and multiply in the most vulnerable groups, such as people suffering from cancer, diabetes, malnutrition or obesity.” Cornejo said. Juarez.

These consequences add to those of the livestock sector, which alone consumes 66 percent of antibiotics worldwide. They are used to treat infections on farms and increase livestock numbers, but the latter practice is excluded from veterinary medicine because it violates international World Organization for Animal Health standards and compromises the fight against bacterial resistance.

In the context of Latin America, the study found that only three of the five major meat producers—Argentina, Chile and Colombia—have regulations classified as “stringent,” limiting the use of antibiotics as growth promoters. Two other countries, Brazil and Uruguay, have “intermediate” legislation, and all of them lack information on compliance with these laws.

Indiscriminate use of antibiotics is a major accelerator of bacterial resistance and has been linked to the emergence of this characteristic in at least eight bacterial species in the region, suggests a review of studies published over the past decade.

Alejandro Macias, an infectious disease specialist with more than 30 years of medical practice and professor at the University of Guanajuato in Mexico, said: SciDev.Net that the scenario where absolutely no antibiotic works is still rare, but other manifestations of bacterial resistance are an everyday problem.

“Usually people come in with urinary tract infections that no longer respond to oral antibiotics. Therefore, we have to move to injectable options, increase doses, more serious side effects occur, and also increase costs for both families and medical institutions,” commented Macias SciDev.Net.

This is exactly what happened to patient Iniera Hinestroza from Buenos Aires. After 30 days of fighting in the hospital, in conditions of strict isolation and almost exhausting his entire arsenal of antibiotics, he survived. However, he went home with irreversible consequences.

Not everyone can do this. A study published in late 2023 in the journal Emerging Infectious Diseases found that in Latin America the mortality rate from multidrug-resistant bacteria is 45 percent. That is, almost every second person who becomes infected with one of these infections dies. With numbers like these, it could become the leading cause of death in the world unless something is done about it.

This article was produced by Latin America and the Caribbean. SciDev.Net