WHEN MEDICINES DON’T WORK ANYMORE

A global action plan must be launched urgently to address the antibiotic resistance crisis, writes

THE growing crisis of antibiotic resistance is catching the attention of policymakers, but not at a rate enough to tackle it. More diseases are affected by resistance, meaning the bacteria cannot be killed even if different drugs are used on some patients, who then succumb.

We are staring at a future in which antibiotics don’t work, and many of us or our children will not be saved from tuberculosis (TB), cholera, deadly forms of dysentery and germs contracted during surgery.

The World Health Organisation will discuss a resolution in May at its annual assembly of Health Ministers on microbial resistance, including a global action plan. There have been such resolutions before but little action.

This year may be different, because powerful countries like the United Kingdom are now convinced that years of inaction have caused the problem to fester, until it has grown to mind-boggling proportions.

The UK-based Chatham House held two meetings last October and last month (together with the Geneva Graduate Institute) on this issue, both presided over by the Chief Medical Officer of England, Professor Dame Sally Davies.

In a recent book,

Davies said: “I am not easily rattled, but what I learnt scared me, not just as a doctor, but as a mother, wife and friend. Our findings were simple: We are losing the battle against infectious diseases. Bacteria are fighting back and are becoming resistant to modern medicine. In short, the drugs don’t work.”

Davies told the meetings that antibiotics add on average 20 years to our lives and that for over 70 years they have enabled us to survive life-threatening infections and operations.

“The truth is, we have been abusing them as patients, as doctors, as travellers and in our food,” she says in her book.

“No new class of antibacterial has been discovered for 26 years and the bugs are fighting back. In a few decades, we may start dying from the most commonplace of operations and ailments that can today be treated easily.”

At the two Chatham House meetings, which I attended, different aspects of the crisis and possible actions were discussed. In one of the sessions, I made a summary of the actions needed, including:

scientific research of how resistance is caused and spread, including the emergence of antibiotic-resistance genes as in the NDM-1 enzyme, whose specialty is to accelerate and spread resistance within and among bacteria;

in every country to determine the prevalence of resistance to antibiotics in bacteria causing various diseases;

guidelines and regulations in every country to guide doctors on when (and when not) to prescribe antibiotics, and instructing patients how to properly use them;

for drug companies on ethical marketing of their medicines, and avoiding sales promotion to doctors or the public that leads to over-use;

the public on using antibiotics properly, including when they should not be used;

use of antibiotics in animals and animal feed that induce growth of the animals (for commercial profit); restrict use in animals only for treating ailments;

the development of new antibiotics and in ways (including financing) that do not make the new drugs the exclusive property of drug companies; and,

ordinary and poor people in developing countries have access to the new medicines.

On the first point, an alarming development has been the discovery of a gene, the NDM-1, that has the ability to alter bacteria and make them highly resistant to all known drugs. In 2010, only two types of bacteria were found to be hosting the NDM-1 gene — E-Coli and Klebsiella pneumonia. It was found that the gene can easily jump from one type of bacteria to another. In May 2011, scientists from Cardiff University found that NDM-1 has been jumping among various species of bacteria at “superfast speed” and without much of a problem.

While the gene was found only in E-Coli when it was initially detected in 2006, now scientists have found that more than 20 different species of bacteria have NDM-1. In May 2011, when there was an outbreak of a deadly disease caused by a new strain of the E-Coli bacteria, it killed more than 20 people and affected another 2,000 in Germany.

Although the “normal” E-Coli usually produces mild sickness in the stomach, the new strain of EColi 0104 causes bloody diarrhoea and severe stomach cramps, and in more serious cases, damages blood cells and the kidneys. A major problem — the bacterium is resistant to antibiotics.

TB is a disease making a comeback. In 2011, WHO found there were half a million new cases in the world that were multidrug resistant (MDR-TB), meaning they could not be treated using most medicines. About nine per cent of multidrug resistant TB cases also have resistance to two other classes of drugs, known as XDRTB.

Research has also found that in Southeast Asia, strains of malaria are becoming resistant to treatment. In 2012, WHO directorgeneral Dr Margaret Chan warned that every antibiotic ever developed was at risk of becoming useless.

“A post-antibiotic era means in effect an end to modern medicine as we know it. Things as common as strep throat or a child’s scratched knee could once again kill.”