Info Service on Health Issues (May14/01)
6 May 2014
Third World Network
WHO sounds alarm bell on antibiotic resistance
Published in SUNS #7797 dated 6 May 2014
5 May (Martin Khor*) -- The World Health Organisation (WHO) has sounded
a loud alarm bell that many types of disease-causing bacteria can
no longer be treated with the usual antibiotics and the benefits of
modern medicine are increasingly being eroded.
The WHO last week released a comprehensive 232-page report on antimicrobial
resistance with data from 114 countries showing how this threat is
happening now in every region of the world and can affect anyone in
Antibiotic resistance - when bacteria evolve so that antibiotics no
longer work to treat infections - is described by the WHO report as
"a problem so serious that it threatens the achievements of modern
"A post-antibiotic era, in which common infections and minor
injuries can kill, far from being an apocalyptic fantasy, is instead
a very real possibility for the 21st century," said Dr Keiji
Fukuda, WHO assistant director-general who coordinates its work on
"Without urgent, coordinated action, the world is headed for
a post-antibiotic era, in which common infections and minor injuries
which have been treatable for decades can once again kill.
"Effective antibiotics have been one of the pillars allowing
us to live longer, live healthier, and benefit from modern medicine.
Unless we take significant actions to improve efforts to prevent infections
and also change how we produce, prescribe and use antibiotics, the
world will lose more and more of these global public health goods
and the implications will be devastating."
The report, "Antimicrobial resistance: global report on surveillance",
shows that resistance is occurring in many bacteria causing different
The report focuses on antibiotic resistance in seven bacteria responsible
for common, serious diseases such as bloodstream infections (sepsis),
diarrhoea, pneumonia, urinary tract infections and gonorrhoea.
What is especially alarming is that the bacteria's resistance has
also breached "last resort" antibiotics, which are the most
powerful medicines that doctors resort to when the usual ones do not
When patients do not respond to the usual medicines (known as first-line
or first-generation medicines), doctors prescribe newer (second-line)
medicines which usually also cost more.
When these also don't work, newer and often more powerful (but sometimes
with also more side effects) antibiotics are used, and they are even
If these third-line or "last resort" medicines are not available
or too costly for the patient, or if they don't work on a patient
because of antibiotic resistance, the patient remains ill or dies
if the infection is a serious one.
New antibiotics have been discovered in the past to treat infections
when the old ones became useless due to resistance. But these discoveries
dried up in the past 25 years. The last completely new classes of
anti-bacterial drugs were discovered in the 1980s.
Pathogens that are becoming increasingly resistant including to the
more powerful antibiotics include E. coli, K. pneumoniae, S. aureus,
S. pneumonia, salmonella, shigella and n. gonorrhoeae.
Key findings from the report include:
* Resistance to the treatment of last resort for life-threatening
infections caused by a common intestinal bacteria, K. pneumoniae -
carbapenem antibiotics - has spread worldwide. K. pneumoniae is a
major cause of hospital- acquired infections such as pneumonia, bloodstream
infections, infections in newborns and intensive-care unit patients.
In some countries, because of resistance, carbapenem antibiotics would
not work in more than half of people treated for K. pneumoniae infections.
* Resistance to one of the most widely used antibacterial medicines
for the treatment of urinary tract infections caused by E. coli -
fluoroquinolones - is very widespread. In the 1980s, when these drugs
were first introduced, resistance was virtually zero. In many countries
today, this treatment is ineffective in more than half of patients.
* The sexually transmitted disease, gonorrhoea, may soon be untreatable
unless there are new drugs. Treatment failure to the last resort of
treatment for gonorrhoea - third generation cephalosporins - has been
confirmed in several countries. In 2008, there were 106 million new
cases of gonorrhoea.
* Antibiotic resistance causes people to be sick for longer and increases
the risk of death. For example, people with MRSA (methicillin-resistant
Staphylococcus aureus) are estimated to be 64% more likely to die
than people with a non-resistant form of the infection. There are
many cases of patients being infected by MRSA in hospitals.
The report also gives useful information on the worrisome building
up of resistance in four serious diseases - tuberculosis, malaria,
HIV and influenza.
The re-emergence of tuberculosis (TB) is especially of great concern.
Increasing cases of TB cannot be treated by most known antibiotics.
In 2012, 8.7 million people developed TB and 1.3 million died; 3.6%
of new cases and 20% of previously treated cases had multi-drug-resistant
The malaria-causing bacteria have become increasingly resistant firstly
to chloroquine and pyrimethamine and now resistance to artemisinin
has been identified in some cases in Cambodia, Myanmar, Thailand and
Vietnam. In 2010, 219 million cases of malaria occurred worldwide
and 660,000 died from the disease.
A major factor accelerating resistance is in the animal husbandry
sector, where there is a liberal use of antibiotics mainly to promote
the growth of the animals used for food, for commercial purposes.
This builds up resistance in the bacteria present in the animals.
These resistant germs are passed on to humans who consume the meat.
The WHO report has a small section on the animal-food chain, which
has been identified as a major problem.
The European Union has banned the use of antibiotics as growth promoters
in animals, but it is still allowed in other countries.
The WHO report mainly provides information on the prevalence and problems
of microbial resistance, rather than what to do about the emerging
However, a WHO press release on the report calls for some actions.
* Setting up basic systems in countries to track and monitor the problem;
* Preventing infections from happening in the first place to reduce
the need for antibiotics;
* Only prescribing and dispensing antibiotics when they are truly
needed; and prescribing and dispensing the right antibiotic(s) to
treat the illness;
* Regulating and promoting appropriate use of medicines;
* Patients using antibiotics only when prescribed by a doctor and
completing the full prescription, even if they feel better, and never
using leftover prescriptions;
* Developing new diagnostics, antibiotics and other tools to stay
ahead of emerging resistance.
(* Martin Khor is the Executive Director of the South Centre.)