Ris­ing re­sis­tance to an­tibi­otics

Imag­ine re­turn­ing to a time when we fear com­mon in­fec­tions and risk our lives from mi­nor surgery. Un­less we im­prove on our short-term so­lu­tions, we will

The New Age (Gauteng) - - OPINION & ANALYSIS - Anal­y­sis Ba­her Ka­mal is an Egyp­tian-born jour­nal­ist with over 43 years of ex­pe­ri­ence

THE world is run­ning out of new an­tibi­otics to com­bat the grow­ing threat of an­timi­cro­bial re­sis­tance, a new spe­cialised re­port warns ahead of this year’s World An­tibi­otic Aware­ness Week, adding that most of the drugs in the clin­i­cal pipe­line are mod­i­fi­ca­tions of ex­ist­ing classes of an­tibi­otics and are only short­term so­lu­tions.

The lat­est World Health Or­gan­i­sa­tion (WHO) re­port on this is­sue – An­tibac­te­rial agents in clin­i­cal de­vel­op­ment: an anal­y­sis of the an­tibac­te­rial clin­i­cal de­vel­op­ment pipe­line, in­clud­ing tu­ber­cu­lo­sis – found very few po­ten­tial treat­ment op­tions for those an­tibi­otic­re­sis­tant in­fec­tions iden­ti­fied by the or­gan­i­sa­tion as pos­ing the “greatest threat to health,” in­clud­ing drug-re­sis­tant tu­ber­cu­lo­sis which kills around 250 000 peo­ple each year. Fact sheet on an­tibi­otic re­sis­tance

The in­dis­crim­i­nate, ex­ces­sive use – and mis­use – of syn­thetic prod­ucts, such as anti-mi­cro­bial medicines, to kill dis­eases in hu­mans, agri­cul­tural and food sys­tems, may be a ma­jor con­duit of the an­timi­cro­bial re­sis­tance that causes 700 000 hu­man deaths each year and has the po­ten­tial to raise this num­ber to up to 10 mil­lion an­nu­ally.

Ac­cord­ing to the UN, an­tibi­otic re­sis­tance is a nat­u­ral phe­nom­e­non of mi­cro-or­gan­isms such as bac­te­ria, viruses, par­a­sites and fungi that are no longer sen­si­tive to the ef­fects of an­timi­cro­bial medicines, like an­tibi­otics, that were pre­vi­ously ef­fec­tive in treat­ing in­fec­tions.

Nev­er­the­less, com­mer­cial prac­tices meant to in­crease ben­e­fits have been lead­ing to the dra­matic fact that these drugs are more and more used al­most en­tirely to pro­mote animal growth, the UN ex­plains.

“An­timi­cro­bial re­sis­tance has the po­ten­tial to be even more deadly than cancer, to kill as many as 10 mil­lion peo­ple a year,” the UN warns.

A global health emer­gency

“An­timi­cro­bial re­sis­tance is a global health emer­gency that will se­ri­ously jeop­ar­dise progress in mod­ern medicine,” Dr Te­dros Ad­hanom Ghe­breye­sus, di­rec­tor-gen­eral of WHO, says.

“There is an ur­gent need for more in­vest­ment in re­search and de­vel­op­ment for an­tibi­otic-re­sis­tant in­fec­tions in­clud­ing tu­ber­cu­lo­sis (TB), oth­er­wise we will be forced back to a time when peo­ple feared com­mon in­fec­tions and risked their lives from mi­nor surgery.”

In ad­di­tion to mul­tidrug-re­sis­tant TB, the UN spe­cialised agency has iden­ti­fied 12 classes of pri­or­ity pathogens – some of them caus­ing com­mon in­fec­tions such as pneu­mo­nia or uri­nary tract in­fec­tions – that are in­creas­ingly re­sis­tant to ex­ist­ing an­tibi­otics and ur­gently in need of new treat­ments.

The re­port iden­ti­fies 51 new an­tibi­otics and bi­o­log­i­cals in clin­i­cal de­vel­op­ment to treat pri­or­ity an­tibi­otic-re­sis­tant pathogens, as well as tu­ber­cu­lo­sis and the some­times deadly di­ar­rhoeal in­fec­tion, clostrid­ium dif­fi­cile. Among all these can­di­date medicines, how­ever, only eight are classed by WHO as in­no­va­tive treat­ments that will add value to the an­tibi­otic treat­ment ar­se­nal. “Phar­ma­ceu­ti­cal com­pa­nies and re­searchers must ur­gently fo­cus on new an­tibi­otics against cer­tain types of ex­tremely se­ri­ous in­fec­tions that can kill pa­tients in a mat­ter of days be­cause we have no line of de­fence,” says Dr Suzanne Hill, di­rec­tor of the Depart­ment of Es­sen­tial Medicines at WHO.

To counter this threat, WHO and the Drugs for Ne­glected Dis­eases Ini­tia­tive set up the Global An­tibi­otic Re­search and De­vel­op­ment Part­ner­ship. On Septem­ber 4, Ger­many, Lux­em­bourg, the Nether­lands, South Africa, Switzer­land and the UK with the Well­come Trust, pledged more than ¤56m (R895m) for this work.

“Re­search for TB is se­ri­ously un­der­funded, with only two new an­tibi­otics for treat­ment of drug-re­sis­tant TB hav­ing reached the mar­ket in over 70 years,” Dr Mario Rav­iglione, di­rec­tor of the WHO Global TB Pro­gramme says. “If we are to end TB, more than $800m per year is ur­gently needed to fund re­search for new anti-TB medicines.”

The WHO says an­tibi­otics are medicines used to pre­vent and treat bac­te­rial in­fec­tions.

An­tibi­otic re­sis­tance oc­curs when bac­te­ria change in re­sponse to the use of these medicines. Bac­te­ria, not hu­mans or an­i­mals, be­come an­tibi­otic-re­sis­tant.

These bac­te­ria may in­fect hu­mans and an­i­mals, and the in­fec­tions they cause are harder to treat than those caused by non-re­sis­tant bac­te­ria.

“The world ur­gently needs to change the way it pre­scribes and uses an­tibi­otics. Even if new medicines are de­vel­oped, with­out be­hav­iour change, an­tibi­otic re­sis­tance will re­main a ma­jor threat. Be­hav­iour changes must also in­clude ac­tions to re­duce the spread of in­fec­tions through vac­ci­na­tion, hand wash­ing, prac­tis­ing safe sex, and good food hy­giene.”

Seek ad­vice from a qual­i­fied health­care pro­fes­sional be­fore tak­ing an­tibi­otics, he ad­vises. Ris­ing dan­ger­ously

An­tibi­otic re­sis­tance is ris­ing to dan­ger­ously high lev­els in all parts of the world,

WHO re­ports, adding that new re­sis­tance mech­a­nisms are emerg­ing and spread­ing glob­ally, threat­en­ing our abil­ity to treat com­mon in­fec­tious dis­eases, while a grow­ing list of in­fec­tions – such as pneu­mo­nia, TB, blood poi­son­ing and gon­or­rhoea – are be­com­ing harder, and some­times im­pos­si­ble, to treat as an­tibi­otics be­come less ef­fec­tive.

Where an­tibi­otics can be bought for hu­man or animal use with­out a pre­scrip­tion, the emer­gence and spread of re­sis­tance is made worse. Sim­i­larly, in coun­tries with­out stan­dard treat­ment guide­lines, an­tibi­otics are of­ten over-pre­scribed by health work­ers and vet­eri­nar­i­ans and over-used by the public. With­out ur­gent ac­tion, we are head­ing for a postan­tibi­otic era, in which com­mon in­fec­tions and mi­nor in­juries can once again kill.

How to con­trol

An­tibi­otic re­sis­tance is ac­cel­er­ated by the mis­use and overuse of an­tibi­otics as well as poor in­fec­tion preven­tion and con­trol. Steps can be taken at all lev­els of so­ci­ety to re­duce the im­pact and limit the spread of re­sis­tance.

Ac­cord­ing to WHO, to pre­vent and con­trol the spread of an­tibi­otic re­sis­tance, in­di­vid­u­als can only use an­tibi­otics when pre­scribed by a cer­ti­fied health pro­fes­sional, never de­mand an­tibi­otics if your health worker says you don’t need them, al­ways follow your health worker’s ad­vice when us­ing an­tibi­otics and never share or use left­over an­tibi­otics.

In­di­vid­u­als can also pre­vent in­fec­tions by reg­u­larly wash­ing hands, pre­par­ing food hy­gien­i­cally, avoid­ing close con­tact with sick peo­ple, prac­tis­ing safe sex and keep­ing vac­ci­na­tions up to date.

The theme of this year’s World An­tibi­otic Aware­ness Week (Novem­ber 13­19) is Seek ad­vice from a qual­i­fied health­care pro­fes­sional be­fore tak­ing an­tibi­otics – and the WHO says that an­tibi­otics are a pre­cious re­source, so it is im­por­tant to get the right ad­vice be­fore tak­ing them.

“This not only en­sures you and your fam­ily get the best treat­ment, re­spon­si­ble use of an­tibi­otics will also help re­duce the threat of an­tibi­otic re­sis­tance.”

PIC­TURE: FLICKR

THREAT TO HEALTH: Most of the drugs in the clin­i­cal pipe­line are mod­i­fi­ca­tions of ex­ist­ing classes of an­tibi­otics and are only short-term so­lu­tions.

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