Global Battle Urged on Antibiotic Resistance

An international group of infectious disease specialists is calling for the war against antibiotic resistance to expand, with sweeping changes to the way the medications are developed, financed, and used.

Researchers at the US Center for Disease Dynamics, Economics and Policy (Washington DC, USA), Uppsala University (Sweden), and 24 other institutions worldwide argue that the time has come for worldwide, coordinated action to preserve antibiotic effectiveness. While many efforts have been made to describe the many different facets of antibiotic resistance and the interventions needed to meet the challenge, coordinated action is largely absent, especially at the political level, both nationally and internationally. Within just a few years, according to the experts, we might be faced with dire setbacks, medically, socially, and economically, unless real and unprecedented global coordinated actions are immediately taken.

According to the researchers, the causes of antibiotic resistance are complex, and include human behavior at many levels of society. In essence, antibiotic resistance is Darwinian evolution in action, but with the pressure of natural selection on pathogens replaced by human pressure. That pressure takes various forms, including overuse and inappropriate use of antibiotics in healthcare settings, in poor communities, on farms and feedlots, and in the streets of the Third World. However, the researchers noted, more antibiotics are used in animals than in humans by a factor of about four—mostly for non-therapeutic reasons—and resistance that develops in animals can make itself felt in human pathogens.

The major drivers of resistance include self-medication, noncompliance, misinformation, and advertising pressures, combined with ignorance, lack of education, and lack of access to healthcare. The problem is complicated by economic and social barriers to rational use of drugs, for example in hospitals that derive much of their revenue from medication sales. The obvious solution, discovering new drugs, is equally complex. Among other things, the value of new antibiotics to their developers depends on them being widely used; but wide use is the very thing that fuels the development of resistance. The study was published in the December 2013 issue of the Lancet Infectious Diseases.

“Antibiotic resistance is a complex ecological problem which doesn't just affect people, but is also intimately connected with agriculture and the environment,” said lead author Prof. Otto Cars, MD, of Uppsala University. “Poverty compounds the problems, because patients do not have access to clean water and hygiene, and are at an increased risk of acquiring infections.”

“In the past few decades the infrastructure for antibiotic development, both in industry and academia, has decayed, so that few if any new drugs are under development,” added Prof. Cars. “The world is left with a decreasing stock of effective antibiotics, an inadequate pipeline of new classes and analogues, a broken antibiotic market, a paucity of antibiotic discovery infrastructure in academia, and insufficient infrastructure in industry.”

The experts called for a range of new approaches to battle the issue, including strict monitoring of antibiotic use, getting rid of financial incentives to prescribers and dispensers that lead to irrational use, regular revision of standard treatment guidelines, and public educational campaigns. Pay-for-performance policies, audit-feedback mechanisms on antibiotic prescribing rates, and public disclosure of antibiotic prescribing rates of healthcare facilities are also suggested, as are better implementation of basic hygienic routines, reassessment, and improvement of infection control interventions, and development of new rapid diagnostic tests to reduce pressure to use antibiotics empirically.

Related Links:
US Center for Disease Dynamics, Economics and Policy
Uppsala University