Working to Tackle Antibiotic Resistance in Guatemala: Public Health Watch

Guatemala has been in the news lately for all the wrong reasons, with refugees from the gang violence-plagued Central American nation part of the “migrant caravan” currently trapped in diplomatic limbo in Tijuana, Mexico.

However, the country is making progress in a key area of health care—antibiotic stewardship—thanks in no small part to help from Lee E. Morris, MD, a pediatric infectious disease specialist working with Atrium Health in North Carolina and the Charlotte-based Heineman Foundation, a non-profit that works in concert with the health system on medical outreach. Although the issue of antibiotic resistance has been well documented in the United States, data for resource-poor nations such as Guatemala is lacking; that said, figures from the World Health Organization suggest the problem is large in scope, with rates of cephalosporin resistance among patients with uncomplicated urinary tract infections caused by Escherichia coli close to 40%.

“We are still gathering data on resistance rates for common bacteria, particularly among the pediatric population [in Guatemala],” Dr. Morris, who is also medical director of the Pediatric Antimicrobial Stewardship Program at Atrium, told Contagion® in an interview. “In doing rounds with physicians at hospitals in the country, we are noticing really high rates of resistance in both the neonatal and pediatric intensive care units.”

To date, Dr. Morris, who began her work in Guatemala on a volunteer basis just over 3 years ago, has been engaging with providers at 2 government-run hospitals in Esquintla and San Benito, with hopes of adding a government-run pediatric hospital in Puerto Barrios in the coming months. Much of the work to date has focused on learning exactly what role the national government plays in health care policy and delivery and what resources each of the hospitals has available to them. In the first part of 2019, Dr. Morris will be launching a lecture series (both in person and via teleconference, the latter thanks to equipment donated by the Heineman Foundation) with physicians and residents initially, and eventually with nurses as well, on the hazards of antibiotic resistance and appropriate prescribing protocols. Early efforts will be geared toward pediatric infectious disease treatment, with plans to roll out the program to the full hospital system as the program expands.

“All of the hospitals involved have residency programs, so the hope is that the residents will take what they’ve learned and bring it back to their local hospitals,” Dr. Morris explained. “So far, the hospital personnel there have been very receptive to developing their own antimicrobial stewardship programs and attending educational sessions.”

Indeed, the goal is for Dr. Morris to work with local physicians to develop their own antimicrobial stewardship programs as opposed to establishing a cookie-cutter initiative for them. “We believe a program they’ve crafted themselves will be more self-sustainable,” she said.

Thankfully, the Heineman Foundation has been working in Guatemala for decades, donating medical equipment and helping in the construction of new facilities, particularly for pediatric care. Thus, the foundation already has an excellent relationship with—and the support of—the government in the country. Dr. Morris’ project is currently being supported through a $25,000 grant from the foundation.

Still, challenges remain. For example, Dr. Morris has found that many hospitals in the country are not storing drugs appropriately (in many cases, because they lack the proper facilities), and there are cultural issues as well: Under Guatemala’s current system, citizens can obtain many antibiotics from pharmacies as over-the-counter products.

“So basically anytime somebody has a runny nose, [they’re buying antibiotics],” Dr. Morris said. “And, unfortunately, even if what they are taking the drugs for is a bacterial infection, they are often not taking them for the full course, thinking they can save them for later use.”

In other words, there is much work to be done in Guatemala to address the related issues of appropriate antibiotic use and drug resistance. Then again, sadly, the same could be said for almost every country in the world.

Brian P. Dunleavy is a medical writer and editor based in New York. His work has appeared in numerous health care-related publications. He is the former editor of Infectious Disease Special Edition.