is this the beginning of the end of antibiotics? [by. dr graham lister]

Posted by Adrienne Lee

Tue, 31 Jan 2017

September 2016 saw the death in Reno of a woman in her 70s whose condition proved to be resistant to all 26 antibiotics available in US hospitals. She developed a rare infection after treatment in an Indian hospital for a broken femur and was hospitalised with sepsis after returning to Nevada. The news, which was released in January this year, has raised fears that the era of total antibiotic resistance has begun.

This could fundamentally affect the future of medicine, threatening the lives of hundreds of millions of patients across the globe. Experts have warned of the danger of rising antibiotic resistance for several years, due to their misuse in human medicine and animal husbandry and the lack of controlled distribution in many countries. In seeking to understand this issue I found I was able to purchase a single dose of a fourth-generation antibiotic in a wayside shack near Phnom Penh. Medsin members will understand that this is a recipe for developing antibiotic/antimicrobial resistance. While there are a limited number of new antibiotics being researched, it is claimed that the economics of drug development no longer work. New antibiotics are increasingly expensive to develop and require many years of clinical trial, at the same time the speed at which antibiotic resistance develops and spreads across the globe, to make them useless, has increased alarmingly.

In 2016 the UK government published a review with the support of the Wellcome Trust entitled “Tackling Drug-Resistant Infections Globally: The Review on Antimicrobial Resistance”.  In introducing the review David Cameron underlined the gravity of this issue: “If we fail to act, we are looking at an almost unthinkable scenario where antibiotics no longer work and we are cast back into the dark ages of medicine”. The report, which is available at https://amr-review.org/  put forward ten recommendations, estimated to cost $40 billion over ten years:

  • A massive global public awareness campaign
  • Improve hygiene and prevent the spread of infection
  • Reduce unnecessary use of antimicrobials in agriculture and their dissemination into the environment
  • Improve global surveillance of drug resistance and antimicrobial consumption in humans and animals
  • Promote new, rapid diagnostics to cut unnecessary use of antibiotics
  • Promote development and use of vaccines  and alternatives
  • Improve the numbers, pay and recognition of people working in infectious disease
  • Establish a Global Innovation Fund for early-stage and non-commercial research
  • Better incentives to promote investment for new drugs and improving existing ones
  • Build a global coalition for real action – via the G20 and the UN

This is an issue that affects global health across all national boundaries and it is also an intergenerational issue, as antimicrobial resistance will have greatest impact on Medsin members’ millennial generation and beyond. It also raises issues of global health equity, because as effective antimicrobials become rarer, there is little doubt who will be last in line for them. Medsin members may wish to consider their position on this question. It seems that the problem is clear and there are well researched economic, social and medical answers available. What is not evident is action to implement these solutions. Medsin may wish to consider how to stimulate decisive action on this issue.

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