November 11, 2013 3:34:25 am
Unless we counter antibiotic resistance,we risk losing major healthcare advances
Last month,the Centres for Disease Control and Prevention (CDC),the United States federal agency for public health,published a report on the mounting threat of antibiotic resistance. The report,Antibiotic Resistance Threats in the United States 2013,listed and ranked major antibiotic-resistant organisms by their incidence,burden of disease and cost to the healthcare system.
Antibiotic resistance is the phenomenon in which a disease-causing micro-organism,usually a bacterial species,is able to survive after exposure to one or more antibiotic treatments. Microbes,not people,are resistant to antibiotics. A patient infected with an antibiotic-resistant strain of bacteria does not respond to antibiotic therapy and may die as a result of sepsis or other complications resulting from the infection. The CDC report estimates that about 23,000 patients die each year from antibiotic-resistant infections in the US alone. If we are not careful,we will soon be in a post-antibiotic era, Tom Frieden,the CDCs director,said in a media briefing,emphasising that our commonly used antibiotic medications may soon cease to work against diseases. He added,And for some patients and for some microbes,we are already there.
Though the report primarily concerns itself with antibiotic resistance in the US,the problem is global. For example,over the last decade,tuberculosis has become impossible to treat for millions of patients infected with multiple drug-resistant strains (MDR-TB). India,China,and Russia are most affected by MDR-TB cases. Drug resistance arises from improper use or overuse of antibiotics,which is very common in many parts of the world,such as South Asia. Antibiotic resistance is primarily found in hospital-acquired infections.
India has a particularly large burden of antibiotic-resistant strains of microbes,so-called super-bugs,due to the overuse of antibiotic therapy,the non-regulated sale of antibiotics over the counter and the fact that most patients do not complete the full dose of the therapy. There is evidence of excessive antibiotic use in India from a survey published by the Centre for Disease Dynamics,Economics and Policy. It found that Indian pharmacy sales of carbapenems (an antibiotic used against serious hospital infections) increased by nearly six times between 2005 and 2010. A new superbug was found in India in 2010 and called New Delhi Metallo-B-Lactamase-1 (NDM-1). This naming caused great consternation and controversy. The most alarming feature of this superbug was that unlike most drug-resistant bacteria,which are found in hospitals,NDM-1 was also found in samples of tap water in Delhi. This means that antibiotic-resistant strains are spreading rapidly across populations and across the globe.
What does this mean for modern medicine? For one,doctors are having to resort to using older antibiotics on patients,as the new antibiotics no longer work on resistant infections. These older medicines had been discarded because of their known,bad side-effects. This also means that bacteria and other disease-causing organisms are evolving faster than drug development,and our drug research cannot keep up. New types of antibiotics take a significant amount of time to be developed and over the last decades of the 20th century,no major types of antibiotics came into the market. Since 2000,some progress has been made in the form of new classes of drugs,but substantial challenges remain. Secondly,as quoted in the CDC report,loss of effective antibiotic treatments will also undermine treatment of infectious complications in patients with other diseases. Most major medical treatments,like joint replacements,organ transplants,cancer therapy or heart surgery,depend on being able to fight infections with antibiotics. If modern medicine cannot effectively treat those infections,the life-saving medical procedures cannot be safely offered to patients.
Several core actions are needed to fight antibiotic resistance. These public health interventions are applicable to all countries,especially those that have a documented problem of escalating antibiotic resistance. The foremost is the prevention of infections,which can only happen with better sanitation,clean water and increased awareness. Further,data on the incidence of antibiotic resistance and its trends needs to be gathered to enable research on resistant strains. The use of antibiotics must be reduced and monitored. Drugs must be correctly prescribed for serious ailments and the prescribed regimen should be fully completed by the patient. This is particularly important in India,where many patients self-prescribe high-end antibiotics and purchase them over the counter without a prescription. Finally,new diagnostics have to be developed to identify antibiotic-resistant strains and new drugs must be created to combat antibiotic resistance. Otherwise,we risk losing major modern advances in healthcare.
The writer is at the Stanford Biodesign Programme,US.
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