For more than 60 years, antibacterial drugs have been regarded as the panacea to cure infections, whether or not their use is appropriate, and whether the infection was acquired in the community or in the hospital setting. Already in his Nobel Prize speech in 1945, Alexander Fleming, who discovered penicillin, warned that bacteria could become resistant to these remarkable drugs. Indeed, the development of each new antibacterial drug has been followed by the detection of resistance to it. The development of resistance is a normal evolutionary process for microorganisms, but it is accelerated by the selective pressure exerted by widespread use of antibacterial drugs. Resistant strains are able to propagate and spread where there is non-compliance with infection prevention and control measures.
Use of antibacterial drugs has become widespread over several decades (although equitable access to antibacterial drugs is far from being available worldwide), and these drugs have been extensively misused in both humans and food-producing animals in ways that favour the selection and spread of resistant bacteria. Consequently, antibacterial drugs have become less eeffective or even ineffective, resulting in an accelerating global health security emergency that is rapidly outpacing available treatment options.
Until the 1970s, many new antibacterial drugs were developed to which most common pathogens were initially fully susceptible, but the last completely new classes of antibacterial drugs were discovered during the 1980s. It is essential to preserve the efficacy of existing drugs through measures to minimize the development and spread of resistance to them, while efforts to develop new treatment options proceed.
In a recent report, “Worldwide country situation analysis: Response to antimicrobial resistance”, which outlines the findings of a survey conducted by WHO, reveals that while much activity is underway and many governments are committed to addressing the problem, there are major gaps in actions needed across all 6 WHO regions to prevent the misuse of antibiotics and reduce spread of antimicrobial resistance.
The survey had been carried out over a 2 year period from 2012 to 2014, and 133 countries from 6 WHO regions participated.
In a news release Dr Keiji Fukuda, WHO’s Assistant Director-General for Health Security says “This is the single greatest challenge in infectious diseases today, All types of microbes—including many viruses and parasites—are becoming resistant to medicines. Of particularly urgent concern is the development of bacteria that are progressively less treatable by available antibiotics. This is happening in all parts of the world, so all countries must do their part to tackle this global threat.”
“While there is a lot to be encouraged by, much more work needs to be done to combat one of the most serious global health threats of our time,” says Dr Fukuda. “Scientists, medical practitioners and other authorities including WHO have been sounding the warning of the potentially catastrophic impact of ignoring antibiotic resistance. Today, we welcome what has been achieved so far, but much more needs to be done to avoid losing the ability to practice medicine and treat both common and serious illnesses.”
Key findings of the report include:
- Few countries (34 out of 133 participating in the survey) have a comprehensive national plan to fight resistance to antibiotics and other antimicrobial medicines.
- Monitoring is key for controlling antibiotic resistance, but it is infrequent. In many countries, poor laboratory capacity, infrastructure and data management are preventing effective surveillance, which can reveal patterns of resistance and identify trends and outbreaks.
- Sales of antibiotics and other antimicrobial medicines without prescription remain widespread, with many countries lacking standard treatment guidelines, increasing the potential for overuse of antimicrobial medicines by the public and medical professionals.
- Public awareness of the issue is low in all regions, with many people still believing that antibiotics are effective against viral infections.
- Lack of programmes to prevent and control hospital-acquired infections remains amajor problem.
WHO, countries and partners have developed a draft Global Action Plan to combat antimicrobial resistance, including antibiotic resistance, which has been submitted to the sixty-eighth World Health Assembly, taking place in May 2015. Governments will be asked to approve the plan and, in doing so, declare their commitment to address a problem that threatens global health as we know it. One essential step in implementing the Global Action Plan would be the development of comprehensive national plans in countries where they are now lacking and further develop and strengthen existing plans.
Source – WHO News release –29 APRIL 2015