RESUMO
An increasing number of studies pointed out the ubiquitous presence of medical residues in surface and ground water as well as in soil compartments. Not only antibiotics can be found in the environment but also their transformation products about which little information is generally available. The development of bacterial resistance to antibiotics is particularly worrying as it can lead to sanitary and health problems. Studies about the dissemination of antibiotics and associated resistances in the Bolivian Altiplano are scarce. We provide baseline information on the occurrence of Sulfamethoxazole (SMX) and Trimethoprim (TMP) antibiotics as well as on the most common human SMX transformation products (TP) and on the occurrence of sulfonamide resistance genes. The studied water and soil compartments presented high levels of antibiotic pollution. This situation was shown to be mainly linked with uncontrolled discharges of treated and untreated wastewaters, resulting on the presence of antibiotics in the Titicaca Lake. SMX TPs were detected in surface waters and on soil sampled next to the wastewater treatment plant (WWTP). SMX resistance genes sulI and sulII were widely detected in the basin hydrological network, even in areas unpolluted with antibiotics. Mechanisms of co-selection of antibiotic- and metal- resistance may be involved in the prevalence of ARG's in pristine areas with no anthropogenic activity and free of antibiotic pollution.
Assuntos
Antibacterianos/análise , Genes Bacterianos , Lagos/química , Poluentes Químicos da Água/análise , Bolívia , Farmacorresistência Bacteriana/genética , Sulfametoxazol/análise , Trimetoprima/análise , Águas ResiduáriasRESUMO
The author relates her experience as a pharmacist/activist involved in the fight against HIV. She has worked as a health care professional in French Guiana, as an instructor for NGO, and as an activist working with squatters and street people in cooperation with prevention teams. The goal of her action has been to enhance prevention and to enhance social services for the poor and precarious people in particular for women with regard to reproductive health including HIV/AIDS. A record of these activities was kept as a basis for future planning. The data obtained was used to design and implement information, prevention, and risk control measures to assist infected groups with the least access to health care. Based on her experience in the field, the author concludes that effective management of the epidemic crisis in French Guiana will require a radically different strategy from that used in mainland France not only with regard to financial and human resources but also, and above all, to innovative ideas. The author stresses the need to make maximum use of link (network) the city and hospital services taking full advantage of all players involved in patient management and always ensuring that care providers understand the importance of maintaining contact with associations that provide the only direct link with patients in their everyday lives.