Medicine to fight antibiotic-resistant germs being looked at
THE world’s health-care community is scrubbing up to face an old enemy next year. The threat from superbugs is now rated serious enough for medical professionals to take a pause from their preoccupation with the big ones – cancer, heart and brain disease, obesity, and epidemics. The new concern follows decades of complacency during which mankind routinely chalked up wins in the battle against bacteria. Now, doctors say, the odds are stacking up against us. The bacteria, it is becoming clear, was only apparently in retreat and is re-emerging with genetic codes that can resist antibiotics. In summary, we now have superbugs that think nothing of our once-unassailable arsenal of antibiotics.
A public health challenge of “today and tomorrow” is how Dr Liselotte Hogberg, an expert at the Stockholm-based Action on Antibiotic Resistance, sees it. “Modern health-care as a whole is threatened. Procedures that we take for granted today – like organ transplant, care of newborn babies, major surgery or cancer chemotherapy – cannot be done safely if we cannot treat bacterial infections that come after.” Evidence has been piling up. In the European Union, some 400,000 patients are thought to suffer from infections resistant to multiple antibiotics every year, with 25,000 estimated to die from it.
In the United States, a superbug called MRSA affects over 100,000 patients a year. It caused the deaths of over 18,600 patients in 2005, exceeding the combined death rate for breast cancer, Aids and Sars. In Singapore, patients infected with MRSA were 10 times more likely to die compared to uninfected patients on average, according to a soon-to-be published study by the National University Hospital (NUH) and Singapore General Hospital (SGH). If a colour-coded alert could be used to describe the magnitude of the threat from the bugs (with their “never say die” attitude), it would be flashing red. The World Health Organisation is sounding that alert. It has labelled antibiotic resistance as a top threat, and will use the 2011 World Health Day on April 7 to spotlight the looming crisis. It swung to action after requests from member countries, top WHO official Mario Raviliogne told The Straits Times. For starters, the WHO will cable health ministries all over the world the best practices to track and control superbug outbreaks. The most important message, however, will be for the public. Simple and direct, it will say that using antibiotics prudently is the surest way to preserve their effectiveness – as the more antibiotics are abused, the more resistance there will be.
“There is a direct correlation between the amount of antibiotics we dump into the environment and antibiotic resistance,” said Dr Brad Spellberg, an infectious disease specialist at the David Geffen School of Medicine, University of California, and author of Rising Plague, a book focused on the superbug threat.
The US Centres for Disease Control and Prevention said that as much as half of all antibiotic use is unnecessary. Instead of holding on to the precious medicines and using them only to treat life-threatening infections, physicians are routinely prescribing antibiotics when it is not necessary. Also, half of all patients fail to take antibiotics properly or they engage in self-medication.
The EU was alarmed enough to institute an Antibiotic Awareness Day last year to highlight that antibiotics are not effective against viral infections like flu and the common cold. Another point of worry is the high level of antibiotics used in animal feed to boost growth – the Union of Concerned Scientists estimates that 70 per cent of antibiotics in the US is fed to animals. This practice was banned in Europe but continues to flourish in the US. In this scenario, the WHO’s upcoming campaign to raise antibiotic awareness is not a minute too soon. “Publicity campaigns such as these raise public awareness by having an outreach beyond just health-care professionals and the relevant government authorities, thereby increasing the stimulus for change,” said Dr Hsu Li Yang, consultant at NUH’s division of infectious diseases.
The growing antibiotic resistance comes at a time when research into new types of the drug which can tackle the superbug scourge is at a standstill. Very few new antibiotics are being developed and all are in the early stages. No new antibiotic is expected to hit the shelves in at least five years, experts say. There are several reasons for this. Disheartened by how quickly antibiotics are losing their powers, pharmaceutical companies have all but stopped researching new ones for fear they will also be resisted.
Commercial factors stand in the way too. An antibiotic, unlike a drug for a chronic ailment, is prescribed for a week at most, reducing its shelf life and making it less lucrative for these companies. Stricter regulatory standards and bureaucratic practices have also slowed down the process. Only five new antibiotics were approved by the US Food and Drug Administration from 2003 to 2007, compared to 16 from 1983 to 1987. In an urgent plea, the Infectious Diseases Society of America (IDSA) is seeking a global commitment to the research and development of 10 new, safe and effective antibiotics by 2020.
There is some doubt that these superdrugs – as a new class of antibiotic that would be able to outwit resistant bacteria would be called – are the way out. “It does not make financial sense for pharmaceutical companies to spend on discovering new antibiotics. We have to control what we have, and use it wisely,” said Dr Piotr Chlebicki, consultant in the department of infectious diseases at SGH. Although slow and long in coming, there has been some recent political action. In December last year, all the health ministers of the 27 EU member states committed themselves to developing incentives to spur antibiotic research.
Some action is also expected in the US Congress next year, where policymakers have shown interest in the Generating Antibiotic Incentives Now Bill. It would provide economic incentives for antibiotic development and extend patents on certain types of antibiotics to protect them from generic competition. But even a super drug is only a short remedy if we cannot change the way we use antibiotics today, said Dr Hogberg. Ultimately, the onus is on us to stem the crisis.
The IDSA’s Antimicrobial Availability Task Force chairman David Gilbert said in April: “Prior generations gave us the gift of antibiotics... Today, we have a moral obligation to ensure this global treasure is available for our children and future generations.”