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"Antibiotics were one of the most significant discoveries of the 20th century. Killer diseases such as tuberculosis, meningitis, scarlet fever, and pneumonia could suddenly be treated and cured," says Gro Harlem Brundtland, MD, director general of the World Health Organization (WHO) in Geneva, Switzerland. "Unless we act to protect these medical miracles, we could be headed for a post-antibiotic age in which many medical and surgical advances could be undermined by the risk of incurable infection."
Over the past five years, more than $17 billion has been spent by the pharmaceutical industry on research and development of medicines to treat infectious diseases. Unless drug resistance is tackled quickly, much of that investment could be lost. As a result of three years of work with national and international partners, WHO is launching a new, comprehensive strategy to contain the spread of drug resistance.
"This strategy is designed to promote the wiser use of drugs so that resistance is minimized and effective treatments can continue to be used for generations to come," says David Heymann, MD, WHO executive director for communicable diseases.
WHO’s global strategy recommends a series of actions, including obligatory prescriptions for all antibiotics used for disease control in animals and phasing out the use of antibiotics as growth promoters in the farming industry. Currently, 50% of all antibiotic production is used in agriculture, mostly to promote livestock and poultry growth. Drug-resistant microbes in animals can be transferred to humans.
"There is indisputable evidence of resistance to medicines used to treat meningitis, sexually transmitted diseases like gonorrhea, infections acquired in hospitals, and even to the new classes of antiretroviral drugs used to treat HIV," Heymann says. Additionally, in several countries tuberculosis strains have become resistant to at least two of the most effective drugs used against the disease. In many areas, commonly used antimalarial drugs have become virtually useless because of acquired resistance of the malaria parasite.
Leading international microbiologists met recently in Hamburg, Germany, to review the latest results of the Mystic surveillance program, which collects data from hospitals around the world that use broad-spectrum antibiotics. The program compares the susceptibility of bacterial isolates in specialist and general hospital patients and correlates the information with resistance trends.
Delegates found that the study provided firm evidence that certain antibiotics, especially carbapenems, continue to be effective. "In some participating hospitals, resistance to antibiotics such as the penicillins, cephalosporins, aminogylcosides, and fluoroquinolones has increased dramatically," noted Ronald Jones, MD, Mystic summit meeting chairman and team leader. "Mystic has a pivotal role to play in global surveillance, and we need to continually share information and be prepared to modify and improve the program to help hospitals change their prescribing practices to minimize resistance," he said.
"[Drug resistance] is a problem faced in both rich and poor communities, in industrialized as well as developing countries," Heymann said. "It has different roots in different societies — overuse of drugs in many developed countries and underuse in poorer nations — but the net result and the imminent danger are the same."