Monday March 18, 2013
Drug resistance now a nightmare
By MARTIN KHOR
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 that a close relative had died after being infected by a superbug 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 becomes immune to the medicines given to a sick patient 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.
When the dangerous pathogens out-run the drugs developed to combat them, humanity is at risk of losing the race between life and death.
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 the alarm bells.
Davies, the top health official in the UK, 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.
Frieden evoked a “nightmare” scenario, a “very serious” problem caused by the advance of 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); and 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.
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, during 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.
“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.
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 that are resistant to many or even all available drugs.
Another classical disease with increasing drug resistance is gonorrhoea.
Davies’ 152-page 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,” said a press release on the report.
Meanwhile, Frieden 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 10 years.
According to Frieden, CRE was found in 4.6% of hospitals and 17.8% 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 is in the pipeline across the world, said Davies.
“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.”