Small islands, big step: tackling antibiotic resistance in Solomon Islands

November 2015

Muriel FeaKali with her mother Janet, Dr Alex Munamua (NRH Surgeon), Julie Zinihite (Chief Pharmacist)
WHO/S. Burggraaf

Eight-year-old Muriel FeaKali was climbing an apple tree in her home village of Nafinua, Solomon Islands, when she fell and broke her arm. Her injury soon became infected, requiring specialist treatment.

Getting to health facilities in the Solomon Islands can be a challenge. Muriel first endured a 45-minute boat trip to the clinic where she was first treated, then a long truck ride to the provincial hospital, and a further 3-hour boat trip to the National Referral Hospital in the capital city, Honiara.

Muriel was prescribed antibiotics to treat her bone infection. Her surgeon, Dr Alex Munamua, happened to also be the Chair of the Antibiotic Stewardship Committee and was able to consult on Muriel’s injury and insert the pins to fix her broken and infected bone.

Medicines can help you or hurt you

‘Medicines can help you or hurt you’ is the motto of the pharmacy division of the Solomon Islands’ Ministry of Health and Medical Services (MHMS). Improving the way medicines such as antibiotics are prescribed, dispensed and used is critical to ensuring patients like Muriel recover quickly. It is also vital to ensuring that the medicines remain effective for as long as possible.

Solomon Islands is one of many countries where the misuse of antibiotics is being targeted because of concern about the development of antibiotic resistance: a major threat to global health.

Antibiotic resistance

Antibiotics are used to treat or prevent bacterial infections. Over time, bacteria adapt and antibiotics stop working. Misuse of antibiotics has accelerated the development of antibiotic resistance. Antibiotic resistance has now reached dangerously high levels—so high, in fact, that the world is losing its ability to treat a growing list of diseases, including types of pneumonia, tuberculosis and gonorrhoea. Others require long and complicated treatments with expensive medicines that can have severe side effects.

A key way of slowing down antibiotic resistance is to ensure they are only given to patients who really need them, and that the right antibiotic is prescribed at the right dose for the right duration.

Solomon Islands rolls out first antibiotic guidelines

With support from WHO, a team of pharmacists, doctors and lab workers from the Ministry recently developed the Solomon Islands’ first set of clinical guidelines to help doctors and nurses make the right decisions about when to prescribe antibiotics, which antibiotics to prescribe, and for how long their patient should take them.

The guidelines take into account the specific antibiotics that are available in the country, the main illnesses that they treat, and the potential side-effects.

“The benefits of the new guidelines should be huge,” says Dr Audrey Aumua, WHO Representative in Solomon Islands. “They will help to ensure every patient gets the best treatment, reduce the spread of antibiotic resistance, and maximize the cost effectiveness of the health system.”

The guidelines were developed at the request of specialist trainees at the national hospital, who applied their recent medical training and advocated for a better approach to prescribing antibiotics. “Their hard work has culminated in these national guidelines. They will benefit patients throughout the country by ensuring they receive the most appropriate treatment available,” says Dr Tenneth Dalipanda, Permanent Secretary at the Ministry.

Implementing the new guidelines and training health workers

In 2005, before the Government rolled out the new guidelines, an antibiotic point prevalence study revealed that less than 5% of antibiotic prescriptions were consistent with good practice laid out in the guidelines. Just 3 weeks after rolling out the guidelines, this figure had risen to 28.6%. Additional training that will take place in the coming months should ensure this number continues to rise.

“All doctors want to give their patients the best possible care, and no prescriber wants to promote the development of antibiotic resistance. But even specialist microbiologists struggle to keep up with all the issues that need to be considered when deciding if an antibiotic—and which antibiotic—should be prescribed in the countless situations arising in day-to-day clinical practice. The new guidelines will help health workers prescribe antibiotics wisely’,” says Dr Dalipanda.

Dr Dalipanda is optimistic about improving antibiotic prescribing practices in Solomon Islands, but he acknowledges that this alone will not solve the problem of resistance. He knows that more needs to be done to ensure treatments are available for those who need them. He also recognizes the need for public awareness on the issue so that people can better understand how to use antibiotics and help reduce antibiotic resistance.

Muriel’s story shows that when antibiotics are prescribed and used appropriately they can effectively treat infections. Muriel is recovering well from her injury and will soon be climbing the trees in her village again.