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Antibiotic Resistance May Lead to Major Global Crisis

Overuse and misuse of antibiotics thought to be the cause

Fears of a "looming" global crisis of antibiotic-resistant superbugs intensified last week as new data revealed alarming rates of bacteria resistant to last-resort antibiotics that can lead to life-threatening infections across the world.

Fierce Healthcare reports that the problem is due to overuse and misuse of antibiotics, according to researchers, who also rejected the notion that new antibiotics could help resolve the world-wide crisis.

"No matter how many new drugs come out, if we continue to misuse them, they might as well have never been discovered," said Ramanan Laxminarayan, director of the Center for Disease Dynamics, Economics & Policy (CDDEP) and co-author of the report, "State of the World's Antibiotics, 2015." Instead, he said, the only sustainable solution is to limit overuse and misuse of antibiotics.

Although wealthy countries like the U.S. still use far more antibiotics per capita, the new data reveal high rates of use in low- and middle-income countries. For example, in India, 57% of the infections caused by the deadly superbug Klebsiella pneumoniae were resistant to carbapenem antibiotics, a last-resort drug, in 2014, compared to 29% six years earlier. In comparison, these same drugs are still effective against the infections in 90% of cases in the U.S. and more than 95% of cases in most of Europe.

"Carbapenem antibiotics are for use in the most dire circumstances—when someone's life is in danger and no other drug will cure the infection," said Sumanth Gandra, an infectious diseases physician and CDDEP Resident Scholar in New Delhi. "We're seeing unprecedented resistance to these precious antibiotics globally, and especially in India. If these trends continue, infections that could once be treated in a week or two could become routinely life threatening and endanger millions of lives."

The data also reveal infection rates caused by 12 common and potentially deadly bacteria, including Escherichia coli, Salmonella, and methicillin-resistant Staphylococcus aureus (MRSA).

The report outlines six strategies that all countries can follow to halt the spread of resistance:

  1. Improve water, sanitation, and immunization. Better access to clean water and sewerage systems and improved coverage for existing and new vaccines will ensure a safe and healthy food supply, reducing the need for antibiotics and thus reducing antibiotic-resistance rates.
  2. Improve hospital infection control and antibiotic stewardship. The report calls for better hygiene, particularly hand-washing between patients, and implementation of antibiotic stewardship programs to reduce infection rates.
  3. Eliminate economic incentives that encourage antibiotic misuse and overuse in hospitals, communities, and agriculture.
  4. Reduce and eventually phase out antibiotic use for growth promotion in agriculture.
  5. Educate health professionals, policymakers, and the public on antibiotic use and promote conservation.
  6. Work with politicians to gain their support for policies to address the threat of antibiotic resistance.

The U.S. has recently acted to address the growing threat. The Department of Health and Human Services (HHS) announced the establishment of a Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria to provide advice, information, and recommendations to the HHS regarding programs and policies related to combating antibiotic-resistant bacteria.

HHS also announced a strategic alliance with a global biopharmaceutical company to accelerate the development of new drugs to treat multidrug-resistant bacterial infections. Although the CDDEP report said only 20% of efforts should focus on new drug development, HHS said in the announcement that lack of investment in new drugs has helped create a "perfect storm" with the rise of antibiotic-resistant infections.

The Joint Commission has also launched a Speak Up on Antibiotics campaign to help educate the public on the appropriate and safe use of antibiotics, as well as the risks associated with antibiotic overuse. The campaign includes a complete package of free resources, including an infographic, podcast, and video.

Source: Fierce Healthcare; September 17, 2015.

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