The stark impact of antimicrobial resistance is all around us. Just a few weeks ago, a woman in the US who could not be treated with any available antibiotics (26 to be precise) died. And recently, results of a study demonstrated that four patients had malaria that was resistant to the most commonly used antimalarial in the UK. Similarly, we are seeing outbreaks of both gonorrhoea and fungal infections that are multi-resistant.
The failure of treatment for gonorrhoea has been confirmed in at least 10 countries including the UK, Australia, Canada and France.
Antimicrobial resistance is more common in some parts of the world than others. For example, it was estimated that there were 214,000 neonatal deaths attributable to resistant sepsis infections globally in 2013. 111,523 of these occurred in the five countries with the highest numbers of neonatal deaths in the world: India, Pakistan, Nigeria, Democratic Republic of Congo and China.
A major area of concern for health professionals is drug-resistant tuberculosis. The World Health Organisation estimates that in 2014, there were about 480,000 new cases of multi-drug resistant tuberculosis (MDR-TB), a form of tuberculosis that is resistant to the two most powerful anti-TB drugs. Soaring rates of multi-drug resistant tuberculosis have been found in west Africa, with the highest in the dense population of Lagos, Nigeria, suggesting the seriousness of the epidemic has been considerably underestimated.
Although there is a lot of talk about antibiotic resistance in the future, it is important to realise that we are already seeing the impact of resistant infections in everyday life. Many urinary tract infections are becoming resistant, which can lead to people requiring a hospital stay. Sally Davies, chief medical officer for England, warned last year that 50,000 people are dying every year in Europe and the US from infections that antibiotics have lost the power to treat.
Resistance is not a new problem. Alexander Fleming (1881–1955), who discovered penicillin, warned of the risk of resistance developing as far back as 1945. During his Nobel prize speech in 1945 he said: “The microbes are educated to resist penicillin and a host of penicillin-fast organisms is bred out which can be passed on to other individuals and perhaps from there to someone else and to others until they reach someone with a pneumonia which penicillin cannot save. I hope this evil can be averted.”
Having fewer antibiotics that work will be equivalent to going back to the early 1930s, where infections we now consider trivial thanks to quick treatment by antibiotics will once again be fatal. An infected cut or illness such as pneumonia could once again become mass killers. Resistance is an expected consequence of antibiotic use and its spread is a result of poor infection prevention and control.
A recent global review on antimicrobial resistance (AMR) highlighted that if we do not act now to tackle AMR, infections that are resistant to antimicrobials will kill 10 million people by 2050, and that between 2016 and 2050 the world could expect to lose between $60tn and $100tn worth of economic output [pdf]. The impact of such a cost has been likened by the World Bank to that caused by the 2008 financial crisis.
Our Antibiotic Guardian campaign allows everyone to sign up to a pledge, health professionals or members of the public.
Midwives can pledge to make sure mothers are only given drugs they need and know how to use them. Dentists can pledge to consider drainage for dental issues before using antibiotics. Farmers can pledge to annually review and discuss the antibiotic use on their farm with a vet, and look for ways of optimising use as necessary.
We want people to learn what actions they can personally take to help tackle the problem. Evaluation of the initiative shows that the campaign changes behaviour and increases knowledge and also increases commitment to tackling AMR.
We are also aiming to educate children about the importance of antibiotics. The E-Bug school programme provides resources and educational games in 22 languages covering infection protection and control as well as explaining antibiotics.
In addition to ensuring we make appropriate use of antibiotics for human health, AMR has clear links to both animal health, farming and the environment. The importance of tackling AMR using what we call a “one health” approach is now widely recognised.
The approach is defined as “… the collaborative effort of multiple disciplines to attain optimal health for people, animals and our environment …”. In the UK, for example, the strategy to tackle antimicrobial resistance takes a one health approach with actions for human, animal and environmental health.
No new class of antibiotics has been discovered for a number of years. Even if we discover more, simply replacing old antibiotics with new ones is not the only answer as they could also become ineffective. It is therefore important that everyone does their part to tackle this issue.
Diane Ashiru-Oredope is pharmacist lead for antimicrobial resistance and stewardship at Public Health England.
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