In recent decades the world has been aware of the rise in antibiotic resistant bacteria and has been trying to promote responsible use of antibiotic treatment in an effort to counteract this rise. But it is the first time that the WHO has warned of a much more serious problem since antimicrobial resistance covers a much broader spectrum of microbes (eg. parasites, fungi, and viruses).
If such a resistance is seen the world over, effective treatment of even common infection may be difficult or impossible. According to the report;
Infections caused by resistant microorganisms often fail to respond to the standard treatment, resulting in prolonged illness, higher health care expenditures, and a greater risk of death.
As an example, the death rate for patients with serious infections caused by common bacteria treated in hospitals can be about twice that of patients with infections caused by the same non-resistant bacteria. For example, people with MRSA (methicillin-resistant Staphylococcus aureus, another common source of severe infections in the community and in hospitals) are estimated to be 64% more likely to die than people with a non-resistant form of the infection.
Although this kind of resistance to antimicrobial is being seen more around the world. Unfortunately not only do many of these cases go unreported, but often the infections last longer, leaving the patients infectious for a much longer time period , thus increasing the risk of further spreading the infection to others.
The report also highlights another consequence of AMR (Antimicrobial resistance), when infections fail to respond to first line of drugs, doctors have to resort to more aggressive therapies which are far more expensive, patients need medical supervision for a longer duration and hospital stays are also prolonged. All together these factors significantly increase the health care costs.
According to the report, the economic outcome can be damaging;
The growth of global trade and travel allows resistant microorganisms to be spread rapidly to distant countries and continents through humans and food. Estimates show that AMR may give rise to losses in Gross Domestic Product of more than 1% and that the indirect costs affecting society may be more than 3 times the direct health care expenditures. It affects developing economies proportionally more than developed ones.
Some of the noteworthy resistances being seen globally are:
Resistance in Bacteria
WHO’s 2014 report on global surveillance of antimicrobial resistance reveals that antibiotic resistance is no longer a prediction for the future; it is happening right now, across the world, and is putting at risk the ability to treat common infections in the community and hospitals. Without urgent, coordinated action, the world is heading towards a post-antibiotic era, in which common infections and minor injuries, which have been treatable for decades, can once again kill.
Resistance in Tuberculosis
Globally, 6% of new TB cases and 20% of previously treated TB cases are estimated to have MDR-TB, with substantial differences in the frequency of MDR-TB among countries. Extensively drug-resistant TB (XDR-TB, defined as MDR-TB plus resistance to any fluoroquinolone and any second-line injectable drug) has been identified in 92 countries, in all regions of the world.
Resistance in Malaria
The emergence of P. falciparum resistance to artemisinin in the Greater Mekong subregion is an urgent public health concern that is threatening the ongoing global effort to reduce the burden of malaria. Routine monitoring of therapeutic efficacy is essential to guide and adjust treatment policies. It can also help to detect early changes in P. falciparum sensitivity to antimalarial drugs.
Resistance in HIV
At the end of 2011, more than 8 million people were receiving antiretroviral therapy in low- and middle-income countries to treat HIV. Although it can be minimized through good programme practices, some amount of resistance to the medications used to treat HIV is expected to emerge.
There is no clear evidence of increasing levels of resistance to other classes of HIV drugs. Of 72 surveys of transmitted HIV drug resistance conducted between 2004 and 2010, 20 (28%) were classified as having moderate (between 5% and 15%) prevalence of resistance.
Resistance in Influenza
Several countries have developed national guidance on their use and have stockpiled the drugs for pandemic preparedness. The constantly evolving nature of influenza means that resistance to antiviral drugs is continuously emerging.
By 2012, virtually all influenza A viruses circulating in humans were resistant to drugs frequently used for the prevention of influenza (amantadine and rimantadine). However, the frequency of resistance to the neuraminidase inhibitor oseltamivir remains low (1-2%). Antiviral susceptibility is constantly monitored through the WHO Global Surveillance and Response System.
How can this surge be slowed down?
According to the WHO report, this rise in AMR is the result of a multiple factors.
Here are some suggestions it provides in the report:
People
- using antibiotics only when they are prescribed by a certified health professional;
- completing the full treatment course, even if they feel better;
- never sharing antibiotics with others or using leftover prescriptions.
- enhancing infection prevention and control;
- prescribing and dispensing antibiotics only when they are truly needed;
- prescribing and dispensing the right antibiotic(s) to treat the illness.
- strengthening resistance tracking and laboratory capacity;
- strengthening infection control and prevention;
- regulating and promoting appropriate use of medicines;
- promoting cooperation and information sharing among all stakeholders.
- fostering innovation and research and development of new vaccines, diagnostics, infection treatment options and other tools.
In the end what is the WHO doing to counteract AMR?
In 2014, WHO published its first global report on surveillance of antimicrobial resistance, with data provided by 114 countries.
WHO is guiding the response to AMR by:
- bringing all stakeholders together to agree on and work towards a coordinated response;
- strengthening national stewardship and plans to tackle AMR;
- generating policy guidance and providing technical support for Member States;
- actively encouraging innovation, research and development.
References:
WHO Report on Antimicrobial Resistance (Updated April 2014)
Detect and Protect Against Antibiotic Resistance Budget Initiative (CDC)
WHO report: Antibiotic resistance happening right now all over the world (The Independent-April 30, 2014)
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