Two-time AIGHD intern seeks unique perspective on antibiotic resistance

Intern David van Melle is investigating the global problem of antibiotic resistance by engaging an important population: the very patients who are resistant to the drugs.

David, a third-year Master’s of Medicine student at the Amsterdam UMC, is completing his scientific internship at the Amsterdam Institute for Global Health and Development. He also completed his Bachelor’s thesis through the AIGHD internship program.

Under the supervision of AIGHD education coordinator prof. Guus ten Asbroek and Amsterdam UMC’s prof. Michèle van Vugt, his internship focuses on the issue of antibiotic resistance in low- and middle-income countries.  His research internship is a result of ongoing collaborations between the Amsterdam UMC, University of Ruhuna in Sri Lanka and Duke University.

The final phase of his studies includes conducting qualitative interviews with patients in Sri Lanka, where antibiotics are available without a prescription. Interviews have been conducted with health care providers and physicians in previous studies, however the patient perspective has not been widely explored.

As is the case in many countries, a lack of available diagnostic resources to accurately confirm – or importantly, rule-out – certain diseases and illnesses, along with little regulation around the use of antibiotics, has resulted in inappropriate use.

This persistent misuse and over prescribing has contributed to the emergence of bacteria that are resistant to the very drugs typically used to treat them. For patients, this can mean longer hospital stays, inadequate access to the right treatment and increased risk of death. The World Health Organization estimates that if no action is taken to stop this resistance, an estimated 10 million people will die each year.

Three months in Sri Lanka

Over the next three months, David will interview in-hospital patients to gain insight on their perspective of using antibiotics, how they cope with their illnesses at home and in the community and importantly, better understand their level of awareness of the global health issue of antibiotic resistance. Duke University’s Dr. Gayani Tillekeratne is his local supervisor.

“My goal is to gain more insight from the patient’s perspective around how and why they use antibiotics – for example, do they know antibiotic resistance impacts them?,” he said. “The patient perspective is an important for health policy makers, for example, because the research gives them insight into what types of policies might work moving forward and how they can adapt their systems to promote appropriate antibiotic use.”

David’s research is part of a larger study, Respiratory Infection Severity and Etiology in Sri Lanka (RISE-SL): The Epidemiology, Diagnosis, and Severity of Lower Respiratory Tract Infections at Teaching Hospital Karapitiya, Galle, which investigates antibiotic resistance in people with lower respiratory tract infections. These infections are among the most common types of illness that antibiotics are prescribed to treat.

While some lower respiratory infections are appropriate candidates for antibiotic treatment, viral infections like the flu are often misdiagnosed as bacterial infections and patients may be prescribed antibiotics when they don’t need them.

For David, a career in medicine – and global health – is a natural fit. He recently returned from two months in Tanzania as part of his program.

“In Tanzania, I saw the problems of antibiotic resistance with my own eyes – almost every patient with a fever was treated with very strong antibiotics, called third generation antibiotics. Patients also did not finish their medication course and resistance to antibiotics was not uncommon, so it made me even more aware of the problem and I became interested in doing research in this field” he said.

“I really like taking care of people and always thought that [a career in medicine] was the way to help people in need.”

World Antibiotic Awareness Week

World Antibiotic Awareness Week takes place this week and encourages best practices of antibiotic use and prescription to limit further development of resistance around the world. Along with a number of international organizations, including the World Health Organization, AIGHD is raising awareness of antibiotic resistance. AIGHD’s team is involved in many research projects in this field to better understand and address this emerging global threat.

Learn more about our AMR projects.