Antimicrobial resistance

Last week, medical and public health experts at a World Health Organization meeting in Geneva noted that reports tuberculosis cases with “severe patterns of drug resistance” are on the rise.

Tuberculosis, a bacteria-caused disease of the lungs and respiratory system, is one of many infections that scientists warn are becoming increasingly ineffective against conventional antibiotics.

Earlier this month, the WHO published a new, comprehensive report which finds that many common infections already are more expensive to treat and, in worst cases, the available medication is unable to treat them. However, the reports also highlights success stories in fighting antimicrobial resistance (AMR) by showing how coordinated action can successfully slow down this global health threat.

The 100-page book, which is a product of many of years of work by more than 50 leading experts in AMR, provides some partial answers. It presents numerous examples of actions taken by health care facilities and communities that have succeeded in reducing antimicrobial resistance through large-scale information campaigns.

In 2000, France had the highest antibiotic consumption per capita in the European Union. But after strict regulation of how antibiotics are used and consumed in humans and animals, that figure has dropped significantly.

Evolutionary forces

So why does antimicrobial resistance occur in the first place?

There are several reasons behind the increased level of resistance. The first is that it has become increasingly difficult to find new classes of antibiotics. The second is sheer Darwinian evolution, which has shown that bacteria have adapted to resist these new drugs.

“Resistance is caused by overuse of antibiotics or anti-viral drugs or anti-parasitic drugs, that is drugs for diseases such as malaria, such as influenza or such as tuberculosis,” said David Heyman, the chairman of the Health Protection Agency, in the United Kingdom.

Antibiotics to treat infections came into use during World War II. One of these drugs, penicillin, has saved millions of lives. But, Dr. Heymann noted, by the 1990s, penicillin was no longer effective in treating staphylococcal infections.

“It's only a matter of time until we will see some infections that we cannot treat unless new antibiotics come on line,” he told DW. “So, we are at a point where some scientists are saying that we could revert to a pre-antibiotic era.”

A 'very, very scary situation'

Health experts have said for years that antimicrobial resistance is becoming an increasingly worrying problem around the globe. According to the European Center for Disease Prevention and Control (ECDC), about 25,000 patients die in the European Union alone from an infection with multidrug-resistant bacteria every year.

Last year, an article in the British medical journal The Lancet confirmed that the “superbug” known as NDR-1 had been found in drinking water in India.

But perhaps the more important obstacle has been the lack of incentive. Pharmaceutical companies are focusing on more lucrative diseases like Alzheimer's, obesity and diabetes rather than on new types of antibiotics.

“The reality is the pipeline for new drug development is actually dry,” said Gerald Dziekan, Program Manager of Antimicrobial Resistance at the World Health Organization, and editor-in-chief of the study. “There are a few candidates, but they are very early in the development stages. “

He says pharmaceutical companies are discouraged from developing new antibiotics because the investment is enormous and the returns are very low.

“And this is a very, very, scary situation and I don't think that the majority of the population has actually realized this,” he told DW.

Public awareness

That's what this new study is trying to fix - not only to make the public aware of this problem, but also, to change medical practices around the globe, particularly so that doctors do not overprescribe antibiotics.

The WHO reports also notes that some countries have run successful education campaigns to make people aware of the problem - citing not only France, but also Zambia, where recent changes have been made to the medical school curriculum to include new information about AMR.

“So, these education campaigns, which have been conducted in Europe and North America have been very successful in decreasing demand by patients for antibiotics and that shows up in a decrease in the sale of antibiotics in those countries,” said Dr. David Heymann, the former Assistant Director-General for Health Security at the WHO.

Author: Lisa Schlein, Geneva
Editor: Cyrus Farivar