Global Trends by Martin Khor

Monday 6 September 2010

Alert on new untreatable diseases 

The recent discovery of a gene carried by bacteria that makes some diseases practically  untreatable has raised alarm bells on the growth of antibiotic-resistant bacteria, and the need to counter the unethical promotion and wrong use of medicines.



The discovery of a new and dangerous gene that can make bacteria resistant to powerful antibiotics has once again raised alarm bells about the spread of infections that cannot be treated by medicines.

Last month the Lancet journal reported on the international spread of extensively antibiotic-resistant bacteria called carbapenemase-producing Enterobacteriaceae.

The article identified a new gene that enables some types of bacteria to be highly resistant to almost all antibiotics.  

The gene has been termed NDM-1 (New Delhi metallo-β-lactamase). It is found in India, Pakistan and Bangladesh, and has spread to Europe via patients who travelled to South Asia for medical treatment (which is popularly termed health tourism).

NDM-1 is a gene that can live inside different bacteria, and a bacterium that carries it would become resistant to carbapenem antibiotics.  These are powerful antibiotics used on infections that are hard to treat.

So far the gut bacterium e-coli and the klebsiella pneumonia bacterium (that invades the lungs) have been found to be hosts to NDM-1.  Scientists fear that it can also jump to other bacteria.

This case highlights the dangers to humanity from the fact that many bacteria and other disease-causing microbes can no longer be effectively combatted by many antibiotics and other antimicrobials.

This is because they have become “resistant” to these medicines because new strains of the bacteria have developed to be “stronger” than the medicines intended to deal with them.      

The reason for the build-up of bacterial resistance is that there has been an over-use and wrong use of the antibiotics.  This is due to companies over-promoting their medicines, doctors over-prescribing to patients, and patients themselves wrongly using the medicines.

It defines AMR as the ability of micro-organisms to find ways to evade the action of the drugs used to cure the infections they cause.  It hampers the control of many infectious diseases.

Some bacteria have developed mechanisms which render them resistant to many of the antibiotics normally used for their treatment (multi-drug resistant bacteria).  This is a serious health threat as there may be few or no alternative options for therapy.

The WHO called on countries to implement hospital infection control measures to limit the spread of multi-drug resistant strains and to reinforce national policy on prudent use of antibiotics, so as to reduce the growth of antibiotic resistant bacteria.

It said governments should take four control and prevention measures:

·       surveillance for antimicrobial resistance;

·       rational antibiotic use, including educating healthcare workers and the public in the appropriate use of antibiotics;

·       introducing or enforcing legislation related to stopping the selling of antibiotics without prescription; and

·       strict adherence to infection prevention and control measures, including the use of hand-washing measures in hospitals. 

New strains of pathogens causing diseases such as TB and malaria are now multi-drug resistant, thus increasing the numbers of death.

Many surgical procedures and cancer therapies are not possible without antibiotics to fight infection. Resistance prolongs illnesses and hospital stays, can also cause death, and leads to costs of US$ 4–5 billion per year in the United States and 9 billion euro per year in Europe.

There is thus an urgent need to tackle antibiotics misuse. Data from the WHO show that: 

·       More than 50% of all medicines are prescribed, dispensed or sold inappropriately, and half of all patients fail to take medicines correctly.

·       The overuse, underuse or misuse of medicines harms people and wastes resources.

·       More than 50% of all countries do not implement basic policies to promote rational use of medicines.

·       In developing countries, less than 40% of patients in the public sector and 30% in the private sector are treated according to clinical guidelines.

·       In developing countries, less than 60% of children with acute diarrhoea receive necessary oral rehydration therapy yet more than 40% receive unnecessary antibiotics.

·       Only 50% of people with malaria receive the recommended first-line antimalarial medicine.

·       Only 50–70% of people with pneumonia are treated with appropriate antibiotics, yet up to 60% of people with viral upper respiratory tract infection receive antibiotics inappropriately.

According to the WHO, a major factor for drug over-use is the inappropriate unethical promotion of medicines by pharmaceutical companies. Most prescribers get medicine information from the companies rather than independent sources such as clinical guidelines. This can often lead to overuse.

Second is the profit motive in selling medicines is another factor.  In many countries, drug retailers prescribe and sell medicines over-the-counter. The more they sell the more income they generate, leading to overuse of medicines.

Third is unrestricted availability of medicines. In many countries, prescription medicines such as antibiotics, are freely available over-the-counter. This leads to overuse, inappropriate self-medication and non-adherence to dosing regimes.

And fourth, there is a lack of coordinated national pharmaceutical policy. Less than half of all countries implement the basic policies recommended by WHO to ensure the appropriate use of medicines. 

To improve the rational use of medicines, the WHO proposes that countries form a national body to coordinate policies on medicine use and monitor their impact; and set up guidelines for training, supervision and supporting decision-making about medicines.

The government should introduce regulations to ensure that drug promotional activities meet ethical criteria, and to eliminate financial incentives that lead to improper prescribing.

There should also be a medicines committee in districts and hospitals to improve the use of medicines; and publicly available independent and unbiased information about medicines for health personnel and consumers.