Download Increasing risk of antibiotic resistance demands immediate global

Increasing risk of antibiotic resistance
demands immediate global action
Resistance trends may be moving at a faster pace than previously
believed.
by Rob Volansky
IDN Staff Reporter
November 2008
A return to pre-antibiotic conditions may occur as a result of antibiotic abuse and
declining development of new medicines, according to an analysis published in the
British Medical Journal.
The phenomenon of antimicrobial resistance involves a cross-section of medical,
governmental, organizational and economic factors. An international panel of
researchers attempted to target several elements of the problem. They narrowed the
action points to three key areas: leadership on international and national levels,
change in the behavior of consumers and providers, and the development of
antibacterial agents to match current public health needs.
Otto Cars, MD, PhD, professor of infectious diseases in the department of medical
sciences at Uppsala University in Uppsala, Sweden, discussed the urgency of the
problem of resistance. “It is quite evident that resistance trends are moving at a faster
pace than anyone could expect,” he told Infectious Disease News. “Even a few years
ago, I would not have said something like that. But the reality is that, at the moment,
there may very well be a gloomy picture for the future of antibiotics.”
Government intervention
The researchers wrote that the ultimate responsibility for coordinating strategies to
fight resistance lies in government hands. However, policymakers at national levels
appear to be unable to accept the problem of resistance as a legitimate threat,
according to the researchers. WHO and the World Health Assembly have offered
resolutions and strategies for combating resistance, but there has not been satisfactory
follow-through from governmental organizations. Nor has there been enough
financial or human resource support to implement the initiatives.
A ground-up approach to solutions likely may be most effective. Although
nongovernmental organizations can create plans and conduct research, governments
at all levels need to provide opportunities for implentation of policies, and then to
monitor and execute the programs. National and local officials should be aware of
surveillance policies and intervention strategies recommended by the scientific
community.
Government agencies also should ensure that basic human needs are taken care of to
help promote general public health and prevent disease. Safeguarding drinking water
and sanitation as well as encouraging good nutrition practices all are effective
preventive measures well within the scope of civic jurisdiction.
The report provides examples of countries that have taken the problem of
antimicrobial resistance seriously. Sweden has instituted a multidisciplinary program
to fight resistance; Chile conducted a media campaign and regulatory measures. Both
programs have been successful.
Economic factors
A unique quality of antibiotic resistance is that it does not always conform to
economic boundaries. The researchers wrote that in hospitals in low- or middleincome countries, 70% of neonatal infections were untreatable using antibiotic
regimens recommended by WHO. However, they also wrote that the European
Centre for Disease Control and Prevention recently reported that resistant microorganisms are the most important threat across Europe.
In developing countries, weak health care systems treating poor patients contribute
most significantly to the problem. In high-income nations, strategies for
implementing regulations and policies are not coordinated. For example, antibiotics
are still sold over-the-counter in certain European Union nations, according to the
researchers. Cars said that in some South American countries, antibiotics are
delivered right to one’s door by local pharmacies.
There are tangential factors related to economics that are no less important. The
increasing accessibility of air travel has allowed resistant bacteria to migrate quickly.
Global distribution of food has made resistant foodborne pathogens a worldwide
threat. Poor hygiene, both in hospitals and in the community at large, has facilitated
the spread of resistance in many populations. Though people in developing countries
are often more vulnerable to infections related to hygiene, nosocomial infections like
methicillin-resistant Staphylococcus aureus are developing all over the world,
regardless of economic borders.
Another factor that has developed recently is that of patients becoming consumers.
The availability of health-related information has made the general populace more
knowledgeable about diseases and treatments. The scientific community must make
accurate information regarding antibiotic resistance readily available.
Economic factors also have influenced research into antibiotics. The scientific
community and the pharmaceutical industry simply are not developing antimicrobials
quickly enough to keep pace with the rate of resistance. The reason, largely, is that
the market for antibiotics is small and the development of resistance has exacerbated
that problem. Resistance has increased the demand for new antimicrobials but
decreased the market value for such drugs. Many antibiotics have a finite period of
efficacy, so the incentive to develop new ones is weak.
The researchers offered possible models that may help to increase the incentive to
produce these drugs. Partnerships between public organizations and private
companies may be effective. Economic mechanisms for guaranteeing revenue return
for new products are another possible solution.
The researchers wrote that “a fundamentally changed view of antibiotics is needed.”
This includes patient behaviors. Patient attitudes toward medications often are
dictated by information from their health care providers. The public demand for
antibiotics may decrease if this information includes data on resistance and viable
alternatives to antimicrobial treatments.
This information needs to be disseminated delicately. “Creating a doomsday scenario
will likely do more harm than good,” Cars said. “We need to move cautiously and
patiently. Changing 60 years of behaviors cannot happen overnight.”
Patients cannot be expected to limit their antibiotic use to promote the greater
common good of resistance prevention, according to the researchers. Members of the
scientific community must highlight real risks for individuals abusing antimicrobials.
One possible way of conveying this message is to conduct studies demonstrating the
possibility of individuals becoming carriers of resistant bacteria. People need to know
that antibiotic overuse may put them at risk for more invasive resistant infections in
the future. Cars also said that studies painting a real portrait of the adverse events
caused by antibiotics may be helpful. Data supporting this thesis are available — they
need to be collected and published.
In the end, Cars stressed that the responsibility for meeting the challenge of resistance
is universal. “We all have contributed to the problem, so we all must contribute to the
solution,” he said. “We all have been fooled, even those of us in the medical and
scientific communities. It is as though there has been some great self-deception.
Governments need to take the lead, but everyone has a part.”
Editor’s Note: Some of us have been preaching about antibiotic resistance for the past 40
years. It is not a new phenomenon. What is new is that we are running out of new drugs.
– Theodore C. Eickhoff, MD
IDN Chief Medical Editor
For more information:

Cars O, Högberg LD, Murray M. et al. Meeting the challenge of
antibiotic resistance. BMJ. 2008;337:726-728.