Spread of Antimicrobial Resistance Causes WHO to Declare: “The World is on the Brink…”
This surprised me: “Each year there are about 440,000 new cases of multi-drug resistant tuberculosis, resulting in at least 150,000 deaths.”
Coming To A Town Near You – Antibiotic Resistant Bacteria
April 18th, 2011
Be afraid. Be very afraid.
The widespread misuse of antibiotics is rapidly rendering them powerless against infection. Common infections that are easily cured today are going to become deadly, and it’s going to happen sooner than you think.
The World Health Organization reports:
* Each year there are about 440,000 new cases of multi-drug resistant tuberculosis, resulting in at least 150,000 deaths.
* Resistance to antimalarial drugs chloroquine and sulfadoxine-pyrimethamine is now widespread in most malaria-endemic countries, leading to the resurgence of malaria in areas where the disease had previously been eradicated.
* A large proportion of infections contracted in hospitals are caused by highly resistant bacteria such as methicillin-resistant Staphylococcus aureus (MRSA).
* An estimated 25,000 patients in the European Union die each year from drug-resistant infections.
Antibiotic resistance arises when the treatment doesn’t kill off the entire infectious population. The genetic variability of bacteria will inevitably make a small portion of them resistant to the antibiotic. These surviving members are then left to proliferate and spread their antibiotic-resistant genes. It’s a consequence that today’s caregivers are aware of, but the rate at which antibiotic resistance is spreading indicates that we’re not doing enough to slow the process.
And maybe we should. Like, now.
Dr. Margaret Chan, the Director-General of WHO, paints a dire picture of our immediate future. Speaking on April 7th in a World Health Day 2011 podcast, Dr. Chan says, “The message on this World Health Day is loud and clear. The world is on the brink of losing these miracle cures. In the absence of urgent corrective and protective actions, the world is heading towards a post-antibiotic era, in which many common infections will no longer have a cure and, once again, kill unabated.” Watch the video and sit in the hot seat and receive a tongue-lashing on behalf of the entire developed world from Dr. Chan.
So why are antibiotics losing their effectiveness? There are a number of factors, but most of the blame lies with doctors who overprescribe the drugs. They’ll prescribe antibiotics that kill many types of bacteria even when the patient is at risk for a specific infection. Unbelievably, doctors will give antibiotics to patients to “cure” conditions that are caused by viruses, such as the common cold. Why? Because the patient insists. Sometimes the doctor is simply too busy to explain to the patient why he or she doesn’t need antibiotics, but in the interest of time prescribes it anyway. Are you kidding me?! Documentation of these incredible findings can be found here.
But doctors don’t shoulder all of the blame. Patients who don’t stick with the prescribed regimen and complete the treatment properly end up feeling better, but they also allow some of the infectious microbes to remain alive, thus allowing them and their resistant genes to proliferate.
Another huge problem is the use of antibiotics in food-producing animals. Approximately half of all antibiotic production is used in agriculture. Factory farms routinely give perfectly healthy animals antimicrobials both as a precaution against infection and to promote growth. This leads to resistant bacteria, which can then spread to humans through the consumption of meat, direct animal contact, or via environmental spread through, for example, contaminated water. This is confounded with veterinarians in many countries whose income is largely derived from the drugs they sell. Try convincing one of these vets to take a hit in the pocketbook for the good of humanity.
For World Health Day 2011 the WHO issued a six point Policy Package To Combat Antimicrobial Resistance. A common component among the points was multi-agency cooperation: governments, doctors, patients, and communities worldwide all working together to stem the antimicrobial tide. A lovely thought, but it’s not going to happen.
Antimicrobial resistance is inevitable. What’s not inevitable is, as Dr. Chan says, “losing these miracle cures.” But, in my opinion, the WHO package is simply unfeasible. At the risk of drawing Dr. Chan’s ire, I think our best hope in fighting antibacterial resistance lies, not in the well-wishing hands of policymakers, but in the self-serving craft of economic forces. Think of MRSA as a new disease, which it is. Drug companies will want to cash in. Each time a new strain crops up that’s resistant to current antibiotics drug companies will scramble over each other to get their pills out first. Speaking of MRSA, Merck and Intercell are well underway testing a vaccine for it in humans. See what I mean?
Granted, a microbial arms race is not the ideal approach. It would be great if governments and doctors and patients would all work together in perfect harmony with the world’s long-term health in mind.
World peace would be great too.
Our misprescribing of pneumonia taught us a lesson: too many antibiotics = high resistance. It seems that we, unlike the microbes, are slow to learn. (From Albrich et al., 2004)
The business of making antibiotics, however, is a lot tougher than it used to be. Since the use of antibiotics became widespread in the 1940s the field has seen a single Golden Age come and go. In the 1950s and 60s developers produced multiple classes of antibiotics to battle diverse types of infections. In the 1980s and 90s they were able only to make improvements within a class. The trend begs the question of whether or not we’ve hit the wall on this one. Have we tapped our antibiotic reserves for every last drop? If so, shouldn’t we be witnessing, now, the emergence of a resistant time bomb? The SARS virus and the avian flu outbreaks had us staring nervously at news flashes as the boundaries of the impending epidemic crept from the far reaches of the globe toward our homes.
And then they were gone.
Vaccines were developed for both, but the SARS epidemic was contained years before its vaccine ever saw the light of day. A rapid, global public health response is what stopped it. Apparenlty, we can work together–when we’re scared to death.
I use SARS as an example of how changing habits in the absence of a cure-all antibiotic or vaccine can be extremely effective–within 6 weeks of its discovery the SARS virus had infected thousands of people on 6 continents–and may be the reason we have yet to see a resistant time bomb. The fear of H1N1 put hand sanitizer dispensers in the lobbies of hospitals, schools, and offices. And they’re there to stay. Now you feel guilty walking by one and not squirting your hands sterile. Everyone’s doing it. Everyone’s hands are sterile.
Simple improvements in hygiene practices are probably behind the recent decrease in MRSA infections contracted in hospitals (healthcare-associated MRSA). Likewise, the continued problem of MRSA infections that begin outside of hospitals (community-associated MRSA) is probably due to a lack of change.
It’s hard to predict the future. The world’s a pretty crowded place. Will the resistance time bomb explode and a microbial butterfly in China cause a pandemic hurricane in Canada? Has the bomb already gone off but we just don’t know it? Or are we kind of like the little buggers themselves, modifying our strategy to counter theirs using a mixture of greed and panic instead of genetic variation?
I’m going to try and not worry about it too much. I’ll take all of my pills (only the necessary ones!), sanitize my hands, and drink my orange juice. And I’ll try to shut out Dr. Chan’s shrill voice, over and over again heeding her warning “…once again, kill unabated…once again, kill unabated.”