For the first time, the World Health Organization has examined antimicrobial resistance globally, and the grim findings won’t be surprising to anyone who’s been following this issue. (Last year, the US CDC and UK’s Chief Medical Officer issued reports with similarly alarming warnings.) The WHO authors write in the report summary:
Antimicrobial resistance (AMR) is an increasingly serious threat to global public health. AMR develops when a microorganism (bacteria, fungus, virus or parasite) no longer responds to a drug to which it was originally sensitive. This means that standard treatments no longer work; infections are harder or impossible to control; the risk of the spread of infection to others is increased; illness and hospital stays are prolonged, with added economic and social costs; and the risk of death is greater—in some cases, twice that of patients who have infections caused by non-resistant bacteria.
The problem is so serious that it threatens the achievements of modern medicine. A post-antibiotic era—in which common infections and minor injuries can kill—is a very real possibility for the 21st century.
The report, which analyzes data from 129 member states’ resistance-surveillance programs, identifies very high rates of resistance among bacteria causing pneumonia, urinary-tract infections, and other common infections. Specifically, many countries reported high rates of resistance to third-generation cephalosporins and to fluoroquinolones among Escherichia coli bacteria that cause urinary-tract and bloodstream infections; resistance to third-generation cephalosporins and carbapenems among Klebsiella pneumoniae bacteria causing pneumonia and bloodstream infections; and methicillin resistance among Staphylococcus aureus bacteria responsible for wound and bloodstream infections (the dreaded MRSA).
In addition, the report describes concerns about multi-drug-resisant tuberculosis, particularly in Eastern Europe and Central Asia; artemisinin-resistant malaria (suspected or confirmed in Cambodia, Myanmar, Thailand, and Vietnam); anti-HIV drug resistance in low- and middle-income countries; and adamantanes resistance in some flu viruses.
“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,” said Dr Keiji Fukuda, WHO’s Assistant Director-General for Health Security, in an accompanying news release. The report stresses the importance of surveillance, and the news release explains that the report “is kick-starting a global effort led by WHO to address drug resistance” that will involve “the development of tools and standards and improved collaboration around the world to track drug resistance, measure its health and economic impacts, and design targeted solutions.”
Surveillance is an important first step toward a global response to this public-health threat, but slowing the evolution of antibiotic resistance will require governments to crack down on problematic uses of antibiotics. In the US, we seem to have an especially hard time stopping the routine use of antibiotics in healthy livestock (that’s where around 70% of US antibiotics go), a practice that allows animals to grow quickly in cramped conditions, but also one that researchers have linked to antibiotic-resistant infections in humans. Cheaper meat is not nearly as important as effective antibiotics. I’d much rather pay more for chicken cutlets in exchange for knowing that the average case of pneumonia, wound infection, or urinary-tract infection is likely to respond to antibiotics. A post-antibiotic future, as the WHO report reminds us, is a grim one.
It is scary to think that these pathogens are able to adapt themselves to become drug resistant. Luckily our safety net in medicine sometimes provides more than one treatment for disease although this comfort shouldn’t be abused. Could a possible reasons for these pathogens becoming drug resistant be the wrongful use of medication for example not using the dosage as prescribed or missing a course of the specific medicine?
By using the blueprint of these pathogens that are able to adapt themselves could scientists possibly use that same idea to develop adapting drugs in an attempt to fight back against these drug resistant pathogens?
Modest proposal: Put all ABs on FDA Schedule II.
Per the Controlled Substances Act, Schedule II is for drugs that have known medical uses and substantial risk for abuse. For example cocaine (local anaesthetic) and morphine (narcotic analgesic).
The idea that “drug abuse” only means “getting high” is frankly puritanical BS dating back to the times when masturbation in your own home was a crime in 1/3 of the states in the USA.
“Drug abuse” in any medical or other scientific sense means “danger to self or others.” AB abuse qualifies hands-down, as the #1 public health threat in our times, followed closely by anti-vax paranoia.
Put ’em on Schedule II and be done with it.
Veterinary ABs too. Farmers can get prescriptions when they need ’em for sick animals, but no more of this “fatten ’em up faster and grow resistant bugs” crap.
As for “oh but it costs money,” so do amputations for MRSA, and so do funerals for children who scraped their knees.
The development of drug resistant strains of diseases is definitely a problem. I found your post highly informative so I went and did a little research. I found out that multidrug-resistant tuberculosis is not the worst strain that exists in South Africa. In 2006 reports were published of an even worse strain that they called extensively drug resistant tuberculosis. This strain can not be treated by some of the most effective drugs available. 53 patients in a rural hospital were reported to have this new strain and of these 53 patients only 1 survived. Most of these patients had not previously received treatment for TB which suggests they were newly infected with it. As of 16 May 2007 314 cases were reported with 215 deaths. Scientist believe the spread of this new strain is related to the high prevalence of HIV. I feel that someone needs to inform all people of the risks of not finishing medicine courses and of relying too much on medicine when it is unnecessary. Do you think that if people are actually informed of the dangers we can prolong the age where medicine can help?
In response to Westley Ferguson’s comment, it certainly does sound like a viable idea to use the blue prints of these pathogens to develop adapting drugs to fight back, against the drug resistant pathogens. Realistically to develop such drugs would require creating an entire new drug and this would involve great research costs to the pharmaceutical companies involved. Looking at drug resistant tuberculosis specifically, there is no incentive for the pharmaceutical companies to develop these new drugs, as DR-TB is most prevalent in poor highly populated communities. There is no financial incentive for pharmaceutical companies to invest in the research of diseases like TB, HIV and Malaria. Compare research in these disease areas versus cardiovascular disease, the greatest cause of mortality in developed societies. Is it therefore not more important for us to continue to focus on the reasons for the multiple drug resistance such as the non-compliance to medicine regimes? Educating the patient at the point of dispensing the medication especially for long-term treatments such as HIV and TB is of paramount importance. This takes time and commitment from all involved in the process.
Westley, patients missing doses or stopping an antibiotic too soon are definitely problems. I don’t know the extent to which scientists are able to develop drugs based on observed resistance patterns, but it’s extremely expensive and time-consuming to develop, test, and get approval for new antibiotics. We simply can’t expect new drugs to be developed as quickly as bacteria evolve resistance.
G, that’s an interesting proposal. I believe one of the criteria for Schedule II listing is that a drug’s abuse may lead to severe psychological or physical dependence, and it’d be harder to argue that antibiotics meet that definition. I agree that we might want to describe antibiotic misuse as a form of abuse, though.
The thing about antibiotics is that people think they are an answer to every single problem, they even go to such an extent that they tell the doctor to prescribe them for their illnesses. And then they don’t take them like they are supposed to
I agree with Dr. Keiji Fukuda, practitioners prescribe antibiotics far to eagerly without a proper examination or understanding the symptoms of the patient. Prevention is more efficient than treatment. This is not a task preformed only by patients but the producers of everyday products as well. If everyone is more prone to healthier lifestyles rather than “quantity over quality” , I believe it can beneficial for the global public health. Maybe a change in the scope of medical treatment is necessary, alternative “products” that are able to adapt to various environmental conditions, along with the resisting bacteria, should be developed, rather than trying to create a drug for each form of the resisting bacteria. Due to the ever changing resistance, this method would be most expensive and time consuming.
This article is really food for thought,and reading some of the previous comments on this article it exposes the moral holes in some pharmaceutical companies.They are not going to spend millions on research and the production of medication if the government will supply at the cheapest cost. They are going to follow and make medication suited where they stand to make the most profit-developed countries where the majority of the life threatening ailments are lifestyle diseases. For example-diabetes type 2,heart disease and so forth. We should be more focused on prevention through education. The misuse of antibiotics has lead to a serious epidemic of drug-resistant pathogens in especially rural areas and will eventually spread further. For masses of people to die of curable and treatable diseases is sad and unnecessary. There should really be awareness campaign about this so more people will know and help,because it seems as if no serious measures are being taken to prevent this if the situation keeps getting worse.
I read a Global report on surveillance and what I absorbed from the report as well as this report was that AMR threatens the prevention and the treatment of the constantly increasing range of infections caused by bacteria, parasites, fungi and viruses. The report referred to this era as a ‘post-antibiotic era’. It is quite startling when one hears of such- that antibiotics might not be as effective as they used to be. And it is not just for such infections, it is for minor injuries as well! When antibiotics were initially introduced, resistant pathogens were very rare. I also read in the report that this resistance actually spreads through communities! Antimicrobial use permitted resistant organisms to thrive within treated patients, and when this spreads, it makes the world vulnerable to untreatable infections. But does anybody think that the severity of the case will make us reach a point where we will encounter untreatable diseases?
i was aware of the dangers of becoming resistant to pharmaceutical drugs however, I was not aware of the rapid speed at which it is currently happening.
this article is very informative and has opened my eyes to the misuse of pharmaceutical drugs and the dangers that follow because i often find myself misusing drugs such as antibiotics as well. This just goes to show that people are not even aware that they are putting themselves at risk, much like myself.
Furthermore, after doing some research of my own I have found that the misuse of pharmaceutical drugs not only puts the particular individual in danger but puts everyone else in danger as well because pathogens can mutate to grow resistant to these drugs causing a peripheral amount of deaths due to easily curable viral infections such as influenza. The numbers of deaths have many repercussions on both the country that the people lived in and their social communities. Also, as pathogens mutate, eventually the world will reach a point where antibiotics cannot be modified anymore without causing actual harm to the human body, thus making us all vulnerable to harmful pathogenic infections that could easily lead to death.
Finally, this article is a crucial eye-opener to the oblivion of people with regard to medication and pharmaceutical drugs and creating awareness about this topic is vital for human survival. Thank you for your efforts on creating awareness about this topic.
Since the early 20th century, the understanding, use and development of antibiotics have flourished. Used for treating almost all bacterial infections, antibiotics revolutionised medicine, improving and saving millions of lives. It is almost impossible to comprehend that there could soon be a time where microorganisms’ resistance will surmount the success of antibiotics. This is indeed a serious worldwide threat. It is easy to identify the role which the Government must fulfil to prevent the obviation of antibiotics, however, there are steps as individuals that we must adhere to in order to impede the further development of bacterial resistance. By creating an awareness of the correct use of antibiotics, we will inhibit the formation of superbugs and reduce the overall rate of resistance. I am most definitely shocked by this information and feel that it is imperative that action is taken immediately.
Rather sooner than later! it is quite logical that at some stage bacteria and other microorganisms will become resistant to antibiotics. The formula and dosages of prescribed antibiotics should regularly be changed to prevent microorganisms to change their blueprint to become resistant. When a course of antibiotics are not taken as prescribed, it happens that the attacking organisms builds up immune against the medication. Thus, the use of the antibiotics will completely be useless.
In our advantage with new and improving technology it will be possible to find a cure other than antibiotics.
I agree with Britney’s comment about the morals of some pharmaceutical companies. I also agree that antibiotics are prescribed too freely. Most doctors and patients are very quick to accept that antibiotics should be the first port of call. Antibiotics are a great achievement in treating diseases that were once life threatening; however doctors need to be wary as to how much antibiotics they are prescribing and if it is necessary for that particular illness. Patients also need to be responsible in taking their required dosage and also educating themselves about what illnesses should be treated with antibiotics. This is an example where the importance of a doctor and his/her patient working together is so important. We are privileged to have antibiotics that are able to destroy these microorganisms in our body, but we need to learn to use them correctly.
In terms of antibiotics being prescribed too readily I believe there should be a bar standard for prescribing such as a blood test positively confirming antibiotics are required for treatment. I recognise , however,then in rural communities that option is not always viable.
When it comes to Drug Resistant TB for example the main reason for this intolerance is the lack of education surrounding the medication. There would be no need for pharmaceutical companies to dive into their pockets to create a new drug for people with evolving TB if people where educated about drug resistance, This keeps happening because people are still not educated and it will continue to happen unless something is done about it. I therefore agree with Britney.S that awareness campaigns should be implemented to prevent these previously treatable illnesses becoming fatal.
It seems that the maim reason for the development of drug-resistant illnesses in the failure of the patients to correctly take medication as prescribed by their practitioner. The pathogen is thus allowed time to develop and grow into drug-resistant forms. it is unfortunate that people do not pick up on this trend, however i think that stressing the importance of the correct use of medication would help in combating a future of drug-resistance diseases
It would seem that people have grown far too dependent on antibiotics. In fact, the unnecessary use of antibiotics may have hindered the evolutionary development of our own immune systems – “survival of the fittest” no longer applies here.
Considering the growing resistance of bacteria against conventional antibiotics, I’d say now is a good time to consider some creative alternatives.
The use of bacteriophages to treat bacterial illnesses for instance, is now gaining popularity. This is because 1: it is a self-replicating cure. And 2: bacteriophages target the bacteria directly, and so produce minimal side-effects (unlike many antibiotics and typical drugs). Here are links for further information http://www.bbc.com/news/health-21799534 and http://www.foodsafetynews.com/2010/11/natural-disease-fighters-eyed-as-antibiotic-alternatives/ .
Another interesting new treatment being worked on, disables the “pump” system of the bacteria, which it uses to expel toxins, so that the bacterium is exposed to the toxin long enough for it to take effect.
Rather than viewing this as a reason for panic (though we should not underestimate it either), we can rather view the antibiotic resistance as a challenge. One that will drive us to improve the field of medicine and pharmaceutical treatment.
It is really shocking to see that antibiotic resistance has become a threat so quickly. Knowing this scary information made me do some further research as to how one may prevent becoming antibiotic resistant. It is said that people can help tackle resistance by:
Using antibiotics only when prescribed by a doctor, completing the full prescription even if they feel better, not skipping doses, never sharing antibiotics with others or using leftover prescriptions.
For me prevention is better than cure and the cause of these antibiotic resistant pathogens might be the incorrect use of it or mutations that these pathogens have undergone, that means that more education about the correct use of antibiotics is required and that more research must be done about the antibiotic that will be more effective.
For the first time ever, Science is moving backwards. The antibiotic resistance plague has indeed come as a shock to the medical world. However, this is a lesson to Medical Scientists that standard treatments to a disease or an infection such as polio-which was a widespread highly infectious disease in the rural areas until 2007 where there has been a decrease ever since thanks to antibiotics and vaccines-will not always be effective. It should be remembered that lifestyles are constantly altering and environmental conditions have worsened.
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.
I find it very frightening that these medications and cures for severe diseases may be rendered obsolete, but regardless of the economic effects, would creating drugs to fight the resistant pathogens not only prolong the inevitable? Would these resistant pathogens not evolve even more than they already have to combat this new enemy? As per the example of the extensively resistant tuberculosis mentioned in previous comments. Will this not be the outcome each time a new counter measure is developed? Economically it may be beneficial for pharmaceutical companies who may continue to obtain new resources for profit but would it in the end be beneficial for the human health?
I did not realize that some pathogens for example Streptococcus pneumonia is in fact, a frequent occupant in our bodies, and killing them by means of antibiotics could open space for different and more harmful pathogens
Finally the issue of drug resistant pathogens are recognized as a serious one globally. It is quite scarry to think that because of these drug resistant pathogens someone cou.d actually die from a disease that would not, under normal circumstances, be seen as a life threatening disease. It is good to see that something is starting to be done about it.
I always knew that a course of antibiotics must be finished , but I never knew that the effects of not finishing it can be so dangerous. It is interesting to know that it is used in healthy livestock just to increase production. It is actually scary to think that livestock are given antibiotics at the expense of peoples health , it can become a very serious health issue if there is not paid attention to . Why don’t we go again and try to live on this earth like we were supposed to ,without antibiotics in cattle ,without all this extra thing and unnatural processes our foods go through.