Global Trends by Martin Khor

Star, Monday 18 March 2013

Drug resistance now a “catastrophe”

Blurb:  Top health officials in the UK and US warn that resistance of bacteria to medicines is a catastrophe and nightmare, and as serious a threat as terrorism and climate change.


Many a Malaysian has lost a family member because of an infection contracted during an operation while in a hospital.

Several office colleagues and friends have told me of a close relative (a mother, a husband, a brother) had died after being infected by a superbug like MRSA, that was so toxic that it could not be eliminated by antibiotics.

This in essence is the problem of antibiotic resistance – that a bacterium can evolve and change so that it become immune to the medicines given to a sick patient and that are meant to kill it.

When a bacterium becomes resistant to one antibiotic, scientists develop a more powerful antibiotic to kill it.  But bacteria can then change to also become immune to the new medicine. 

These bacteria have then developed multi-drug resistance.  And when the dangerous pathogens out-run the drugs developed to combat them, humanity is at risk of losing the race between life and death.

More and more diseases are becoming very difficult to treat or even incurable, as the some pathogens are becoming immune to all antibiotics, including the most powerful ones.

And equally problematic is that many of these incurable diseases are contracted when patients stay in hospitals, especially during operations.

In the past two weeks, two top health officials – the Chief Medical Officer of the United Kingdom Dame Sally Davies and the director of the United States Centres for Disease Control and Prevention (CDC) Dr. Thomas Frieden, – have sounded alarm bells in the most alarming terms.

Davies, the top health official in the U.K. warned of a looming “catastrophe” of antibiotic resistance being so widespread that we would be back to a 19th century medical situation, a pre-antibiotic era when many diseases were difficult or impossible to treat.

And Frieden evoked a “nightmare” scenario, a “very serious” problem caused by the advance of a highly drug-resistant bacteria known as CRE.

A major cause of the acceleration of antibiotic resistance is the inappropriate use of the medicines, and the inadequate action (or even inaction) of health authorities.

Drug companies often over-promote the use and sales of their medicines; some doctors over-prescribe or wrongly prescribe antibiotics (sometimes for the wrong ailment), patients who are not informed enough sometimes pressure their doctors for antibiotics for a quick cure and often do not use the medicines properly by not completing the course of medicines.

And there’s not enough action to make the public aware of the proper use of antibiotics, and not enough regulations (or their implementation) to ensure drug companies and medical personnel sell or prescribe the medicines properly.

The alarm raised by the two top health officials was aimed at pushing the regulators and also the patients into action.

Davies, in media interviews, even placed antibiotic resistance on par with terrorism and climate change as critical risks facing the nation. 

She said:  "Antimicrobial resistance poses a catastrophic threat.  If we don't act now, any one of us could go into hospital in 20 years for minor surgery and die because of an ordinary infection that can't be treated by antibiotics. And routine operations like hip replacements or organ transplants could be deadly because of the risk of infection.

"That's why governments and organisations across the world, including the World Health Organisation and G8, need to take this seriously."

Although there has been a great reduction in cases in English hospitals of MRSA (methicillin-resistant Staphylococcus aureus) which is a skin disease, this has been replaced by many times more cases of “gram-negative” bacteria which are found in the gut.

These bacteria include E coli and Klebsiella (which causes pneumonia) which are resistant to many drugs.  In the U.K. about 5,000 people die annually from gram negative sepsis, in which the bacteria infects the patients’ blood; half the deaths were due to drug resistant organisms.

In Europe as a whole, “25,000 people die each year as a result of hospital infections caused by resistant bacteria, adding €1.5 billion to hospital, treatment and societal costs,” according to a 152-page report issued by Davies.

Besides the new drug-resistant pathogens, resistance is also emerging in old pathogens.  In particular the report cites tuberculosis, which has re-emerged in Europe in the form of new strains of TB that are resistant to many or even all available drugs. Another classical disease with increasing drug resistance is gonorrhoea.

The report also warned of a “discovery void” with few new antibiotics developed in the past two decades.  “While a new infectious disease has been discovered nearly every year over the past 30 years, there have been very few new antibiotics developed leaving our armoury nearly empty as diseases evolve and become resistant to existing drugs,” says a press release on the report.

Meanwhile, Dr Frieden of the CDC has warned about the rapid spread of CRE or the carbapenem-resistant variety of Enterobacteriaceae, a group of   more than 70 bacteria which dwell in the gut, including Klebsiella, Salmonella, Shigella and E. coli.

Carbapenems are powerful drugs that are used as a last resort when the bacteria have become resistant to other drugs.  The occurrence of resistance has risen four-fold in ten years.  According to Frieden, CRE was found in 4.6 percent of hospitals and 17.8 percent of long-term care in 2012.

While resistance is building up, there have been few new antibiotics.  No new classes of antibiotics have been developed since 1987, and none are in the pipeline across the world, said Davies.

She said:  "Antimicrobial resistance is a ticking time-bomb not only for the UK but also for the world. We need to work with everyone to ensure the apocalyptic scenario of widespread antimicrobial resistance does not become a reality. This threat is arguably as important as climate change."

According to a London-based paper, the U.K.’s Chief Pharmaceutical Officer, Keith Ridge, said although the control mechanism for prescribing antibiotics had been strengthened in hospitals, there needs to be tighter and more thoughtful control of antibiotic prescriptions in GPs' surgeries.

The report also contains 17 with recommendations, including putting antimicrobial resistance on the national risk register, better surveillance data to monitor the developing situation; and more work carried out between the healthcare and pharmaceutical industries to preserve existing drugs and encourage the development of new antibiotics to fill the “discovery void” of the last 20 years; and champion the responsible use of antibiotics.