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Resistance crisis looms as antibiotics 'handed out like cough sweets'

Experts have called on global healthcare systems to take action in key areas.

Image: J.M. Guyon - Copyright 2012/Candybox Images/Press Association Images

EXPERTS HAVE WARNED that we are nearing a time when the wonder drugs of the 20th century cease to be useful.

In a study published to mark European Antibiotic Awareness Day tomorrow, and the US Centers for Disease Control and Prevention’s ‘Get Smart About Antibiotics Week’, a number of exports have urged global healthcare systems to take action in a number of key areas to evade the looming crisis.

An editorial in the latest edition of The Lancet Infectious Disease notes that, despite warning, antibiotics have been used with “great profligacy”, including being “pointless prescribed for viral infections”, added to animal feed to boost growth of livestock and “handed out like cough sweets in the community”.

The golden age of antibiotic discovery…is now a distant memory, according to the publication.

And now the entire structure of healthcare delivery for effective antibiotics – from research and development, to distribution and rational use – needs to be re-engineered to address the global threat of antibiotic resistance.

What can be done?

A report, which was compiled by an international group of 26 leading experts in the field on a Lancet commission, presents a comprehensive global overview of the growing problem of antibiotic resistance, its major causes and consequences, and identifies key areas in which action is urgently needed.

“The causes of antibiotic resistance are complex and include human behaviour at many levels of society; the consequences affect everybody in the world,” says lead scientist Professor Otto Cars in Sweden.

“Within just a few years, we might be faced with unimaginable setbacks, medically, socially, and economically, unless real and unprecedented global coordinated actions to improve surveillance and transform the way antibiotics are regulated and developed are taken immediately.”

Antibiotic resistance arises when bacteria evolve mechanisms to withstand the drugs which are used to fight infection. Recent decades have seen vast increases in the use of antibiotics across medicine and agriculture, and in the absence of adequate regulatory controls, treatment guidelines, and patient awareness, this has led to a huge global surge in antibiotic resistance.

The problem is compounded by a desperate shortage of new drugs to treat multi-drug resistant bacterial infections.

“Addressing these problems will require nothing less than a fundamental shift in how antibiotics are developed, financed, and prescribed,” continued Cars, who believes the lack of new antibiotic drugs has come from a combination of significant scientific challenges, low financial returns compared with many other medicines such as those for chronic diseases, and the regulatory environment.

“Rebuilding the infrastructure of academia and industry to face the threat of antibiotic resistance will not only require national and international political commitment and investment, but also new ways of financing drug development.

“Investment in new drugs is usually based on expectations of large volume sales.

In the case of antibiotics, this can lead to aggressive marketing and sales activity, which in turn results in over-prescription, especially when in many countries, financial incentives for doctors and health-care systems mean that over-prescription of antibiotics makes sound financial sense.

Innovative and sustainable financing models which delink research and development investment from revenue returns are now needed, continued Cars and colleagues.

“Antibiotic resistance is a complex ecological problem which doesn’t just affect people, but is also intimately connected with agriculture and the environment,” added the authors.

We need to move on from ‘blaming and shaming’ among the many stakeholders who have all contributed to the problem, towards concrete political action and commitment to address this threat.

“Consumers and providers of antibiotics alike need to be empowered to tackle antibiotic resistance, as well as ensuring that those in need benefit from affordable, effective antibiotics.”

‘Sensitive solutions’

The authors called for a ban on non-prescription sales of antibiotics to help reduce “massive global overuse” but conceded that such a ban could potentially cut off access for some of the world’s poorest and marginalised people.

The solutions, therefore, must be “sensitive to local resources and cultural beliefs as well as empower and engage inclusively consumers and providers alike”.

The experts cited also suggest that academic research institutes and small and medium sized enterprises need to play a greatly-increased part in antibiotic discovery to address the currently inadequate infrastructure and innovative capacity.

“All of this needs to be done in a way that balances curtailing excess antibiotic use with ensuring access to the people who most need them, especially children in the poorest regions of the world.”

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