<div dir="ltr">From: <b class="gmail_sendername">South Centre</b> <span dir="ltr"><<a href="mailto:south@southcentre.int">south@southcentre.int</a>></span><br><div class="gmail_quote"><br></div><div class="gmail_quote"><br></div><div class="gmail_quote">The next time you have a bad cold and reach for the antibiotics left over from your last visit to the doctor, think again.<br>
<br>
Firstly, the antibiotics won’t work as they only act against bacteria while the cold is caused by a virus.<br>
<br>
Secondly, you will be contributing to arguably the world’s gravest health threat – antibiotic resistance.<br>
<br>
The wrong use and over-use of antibiotics is one of the main causes why
they are becoming increasingly ineffective against many diseases,
including pneumonia, tuberculosis, blood disorders, gonorrhoea and
foodborne diseases.<br>
<br>
While an effective antibiotic kills most of the targeted germs, a few
may survive and develop resistance which can spread to other bacteria
that cause the same infection or different infections. The rate of
resistance and its spread can increase if antibiotics are wrongly or
over used, and they then become increasingly ineffective to treat
bacterial infections.<br>
<br>
Global health leaders are now ringing the alarm bell. “Antimicrobial
resistance is a global health emergency,” warned the World Health
Organization’s Director-General Tedros Adhanom Ghebreyesus. “The world
is facing an antibiotic apocalypse,” said the United Kingdom’s Chief
Medical Officer Dame Sally Davies. “It may spell the end of modern
medicine.”<br>
<br>
Warns the WHO: “Antibiotic resistance is rising to dangerously high
levels in all parts of the world. New resistance mechanisms are
emerging and spreading globally, threatening our ability to treat common
infectious diseases…Without urgent action, we are heading for a
post-antibiotic era, in which common infections and minor injuries can
once again kill.” (WHO Fact Sheet on antibiotic resistance, Nov. 2017).<br>
<br>
These warnings were highlighted on World Antibiotics Awareness Week on
13-19 November when activities were held in many countries.<br>
<br>
Antibiotic resistance is part of the wider phenomenon of anti-microbial
resistance (AMR), which includes resistance of bacteria, fungi, viruses
and parasites to medicines.<br>
<br>
About 700,000 people die annually due to antimicrobial resistant
infections, and this is estimated to rise to 10 million deaths a year by
2050 if action is not taken, with a cumulative economic cost of US $100
trillion, according to a 2016 review on AMR sponsored by the UK
government.<br>
<br>
A key tipping point was reached recently when it was found that some
bacteria had evolved to be resistant to colistin, the antibiotic of last
resort which is used on a patient when all other antibiotics are found
ineffective.<br>
<br>
In 2016, researchers in China found colistin-resistant E. coli bacteria
in 20 per cent of animals, 15 per cent of raw meat and 1 per cent of
hospital patients that were sampled. The colistin resistance gene
(mcr-1) could easily be transferred among different bacteria.<br>
<br>
Malaysia was also one of the first countries where scientists found
colistin-resistant bacteria. “Since the publication of our findings,
mcr-1 gene has been found in many other countries,” said Associate
Professor Dr Chan Kok Gan of University Malaya. “This is a frightening
scenario and the whole world should sit up and take action to prevent
further abuse of antibiotics.”<br>
<br>
If this resistance continues to spread, colistin will become less and
less effective and we will eventually lose the “antibiotic of last
resort.”<br>
<br>
The colistin story also carries another lesson. It is widely thought
that resistance is due to over-use of antibiotics by consumers or the
spread of infections caused by resistant bacteria to patients in
hospitals.<br>
<br>
However resistance is also spread through the agriculture sector and the food chain, as shown in the study on colistin in China.<br>
<br>
In many countries, much of the antibiotics used (80 per cent in the case
of the United States) are fed in farms to animals as growth promoters,
to make them grow fatter and faster, as well as to prevent or treat
diseases.<br>
<br>
Resistant bacteria build up in the animals and are present in raw meat.
Some of these bacteria are passed on to humans when they eat the meat.<br>
<br>
In Malaysia, the Department of Veterinary Services in 2012 found that
half of the domestic chickens tested had bacteria that were resistant to
three types of antibiotics (ampicillin, sulphonamide, tetracycline), as
cited in a memorandum by the Consumers’ Association of Penang.<br>
<br>
The environment is another source of the spread of resistance. Residues
and wastes containing resistant bacteria flow from farms and hospitals
and contaminate soils, drainage systems, rivers and seas. Some of these
bacteria find their way to humans.<br>
<br>
The European Union banned the use of antibiotics as growth promoters in
animal feed in January 2006 while the US started action to phase them
out in December 2013.<br>
<br>
In most developing countries, little action has so far been taken.
Hopefully that will start to change. In November 2017, the World Health
Organization issued its first ever guidelines on the use of antibiotics
in food-producing animals.<br>
<br>
“Scientific evidence demonstrates that overuse of antibiotics in animals
can contribute to the emergence of antibiotic resistance,” said WHO’s
Food Safety Director, Dr Kazuaki Miyagishima.<br>
<br>
A WHO-sponsored study published in <i>The Lancet Planetary Health</i> in
November 2017 found that interventions that restrict antibiotic use in
food-producing animals reduced antibiotic-resistant bacteria in these
animals by up to 39%, according to a WHO press release.<br>
<br>
The research paper (authored by William Ghali and 10 other scientists),
reviewed thousands of studies, and selected 179 relevant ones, to find
if there is an association between interventions that restrict
antibiotic use and reduction in the prevalence of antibiotic-resistant
bacteria in animals and in humans.<br>
<br>
The key findings are that:
<ul><li>“Overall, reducing antibiotic use decreased prevalence of
antibiotic-resistant bacteria in animals by about 15% and
multidrug-resistant bacteria by 24-32%.”</li><li>The evidence of effect on human beings was more limited but showed
similar results, “with a 24% absolute reduction in the prevalence of
antibiotic-resistant bacteria in humans with interventions that reduce
antibiotic use in animals.” </li></ul>
This study influenced the development of the WHO’s new guidelines,
which are aimed at influencing policy makers in the agriculture and
health sectors. According to a WHO press release, the guidelines
include:
<ul><li>An overall reduction in the use of all classes of medically important antibiotics in food-producing animals.</li><li>Complete restriction of these antibiotics for growth promotion and for disease prevention without diagnosis.</li><li>Healthy animals should only receive antibiotics to prevent disease
if it has been diagnosed in other animals in the same flock or herd or
fish population.</li><li>Antibiotics used in animals should be from the WHO list as “least
important” to human health and not from “highest priority critically
important.”</li></ul>
In 2015, Health Ministers attending the World Health Assembly adopted a
Global Plan of Action on anti-microbial resistance, and they agreed
that each country should prepare national action plans by 2017.<br>
<br>
Since there are many sources of antibiotic resistance, the national
effort must include not only the health authorities but also those
responsible for agriculture and the environment.<br>
<br>
The health authorities should take action to control the spread of
infections (including in hospitals), carry out surveillance of
antibiotic resistance, introduce and implement regulations and
guidelines on proper prescriptions, ethical marketing of drugs and
rational drug use.<br>
<br>
The agriculture authorities should phase out inappropriate use of
antibiotics for animals, especially for growth promotion, while the
environment authorities should prevent resistant bacteria and genes from
contaminating soils, drainage systems, rivers and seas.<br>
<br>
There should be campaigns to make the public aware of the dangers of
wrongly using antibiotics and that they should not demand that doctors
give them antibiotics unnecessarily.<br>
<br>
The medical profession should adhere to guidelines on the proper use of
antibiotics, while drug companies should not push for maximum sales but
instead advocate prudent use of their antibiotics in both the health or
animal sectors.<br>
<br>
These are the more obvious actions that need to be taken and urgently if
we are to succeed in slowing down the alarming rate of antibiotic
resistance. If we fail, it may well be “the end of modern medicine”,
as the health leaders and the scientists have warned us.<br><br><u></u>
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