Alarm bells over antibiotic resistance
The World Health
Organisation's most comprehensive report to date sounds a warning that
we are entering a world where antibiotics have little effect.
by Martin Khor
The World Health Organisation (WHO) has sounded a warning that many
types of disease-causing bacteria can no longer be treated with the
usual antibiotics and the benefits of modern medicine are increasingly
being eroded.
The comprehensive 232-page report on anti-microbial resistance with
data from 114 countries shows how this threat is happening now in every
region of the world and can affect anyone in any country.
Antibiotic resistance - when bacteria evolve so that antibiotics no
longer work to treat infections - is described by the report as "a
problem so serious that it threatens the achievements of modern
medicine".
A post-antibiotic era, in which common infections and minor injuries
can kill, far from being an apocalyptic fantasy, is instead a very real
possibility for the 21st century," said Dr Keiji Fukuda, WHO assistant
director-general who coordinates its work on anti-microbial resistance.
Without urgent, coordinated action, the world is headed for a
post-antibiotic era in which common infections and minor injuries which
have been treatable for decades can once again kill.Effective
antibiotics have been one of the pillars allowing us to live longer,
live healthier, and benefit from modern medicine.
Unless we take significant actions to improve efforts to prevent
infections and also change how we produce, prescribe and use
antibiotics, the world will lose more and more of these global public
health goods and the implications will be devastating."
The report, "Antimicrobial Resistance: Global Report on
Surveillance", shows that resistance is occurring in many bacteria
causing different infections.It focuses on antibiotic resistance in
seven bacteria responsible for common, seriousdiseases, such as
bloodstream infections (sepsis), diarrhoea, pneumonia, urinary tract
infections and gonorrhoea.
What is especially alarming is that the bacteria's resistance has
also breached "last resort" antibiotics, which are the most powerful
medicines that doctors resort to when the usual ones do not work.When
patients do not respond to the usual medicines (known as first-line or
first-generation medicines), doctors prescribe newer (second line
medicines) which also usually cost more.
When these also don't work, newer and often more powerful (but
sometimes with also more side effects) antibiotics are used, and they
are even more expensive.
If these third-line or "last resort" medicines are not available or
too costly for the patient, or if they don't work on a patient because
of antibiotic resistance, the patient remains ill or dies if the
infection is a serious one.
New antibiotics have been discovered in the past to treat infections
when the old ones became useless due to resistance. But these
discoveries dried up in the past 25 years.
The last completely new classes of anti-bacterial drugs were
discovered in the 1980s.Pathogens that are becoming increasingly
resistant including to the more powerful antibiotics include E. coli, K.
pneumonia, S. aureus, S. pneumonia, salmonelia, shigella and n.
gonorrhoeae.
Key findings from the report include:
Resistance to the treatment of last resort for life-threatening
infections caused by a common intestinal bacteria, K. pneumonia -
carbapenem antibiotics - has spread worldwide.K. pneumoniae is a major
cause of hospital-acquired infections such as pneumonia, bloodstream
infections, infections in newborns and intensive-care unit patients.
In some countries, because of resistance, carbapenem antibiotics
would not work in more than half of people treated for K. pneumoniae
infections; Resistance to one of the most widely used antibacterial
medicines for the treatment of urinary tract infections caused by E.
coli - fluoroquinolones - is very widespread.In the 1980s, when these
drugs were first introduced, resistance was virtually zero.In many
countries today, this treatment is ineffective in more than half of
patients; The sexually transmitted disease, gonorrhoea may soon be
untreatable unless there are new drugs.
Treatment failure to the last resort of treatment for gonorrhoea -
third generation cephalosporins - has been confirmed in several
countries; and
Antibiotic resistance causes people to be sick for longer and
increases the risk of death. For example, people with MRSA (methicillin-resistant
Staphylococcus aureus) are estimated to be 64% more likely to die than
people with a non-resistant form of the infection.
There are many cases of patients being infected by MRSA in
hospitals.The report also gives useful information on the worrisome
building up of resistance in four serious diseases - tuberculosis,
malaria, HIV and influenza.
A major factor accelerating resistance is in the animal husbandry
sector, where there is a liberal use of antibiotics mainly to promote
the growth of the animals used for food, for commercial purposes.
This builds up resistance in the bacteria present in the animals.
These resistant germs are passed on to humans who consume the
meat.The report has a small section on the animal-food chain, which has
been identified as a major problem.The European Union has banned the use
of antibiotics as growth promoters in animals, but it is still allowed
in other countries.
A WHO press release on the report calls for some actions. These
include:
Setting up basic systems in countries to track and monitor the
problem;
Preventing infections from happening in the first place to reduce the
need for antibiotics;
Only prescribing and dispensing antibiotics when they are truly
needed, and prescribing and dispensing the right antibiotic(s) to treat
the illness;
Patients using antibiotics only when prescribed by a doctor and
completing the full prescription; and
Developing new diagnostics, antibiotics and other tools to stay ahead
of emerging resistance.
- Third World Network Features. |