Humans face the very real risk of a future
a world of plummeting life expectancy where people die from diseases easily
treatable today, scientists say.
Experts tracking the rise of drug
resistance say years of health gains could be rolled back by mutating microbes
that make illnesses more difficult and expensive to cure and carry a higher
risk of death.
Some say the threat to well-being is on the
scale of global warming or terrorism – yet resistance is being allowed to
spread through an entirely preventable means – improper use of antibiotics.
"It is a major public health
problem," Patrice Courvalin, who heads the Antibacterial Agents Unit of France's
Pasteur Institute, told AFP.
"It is about more than not being able
to treat a disease. It will erase much progress made in the last 20-30
Without antibiotics to tackle opportunistic
bacteria that pose a particular risk for people who are very ill, major
surgery, organ transplants or cancer and leukaemia treatment may become
impossible, he explained.
"In some parts of the world, already
we have run out of antibiotics," said Timothy Walsh, a professor of
medical microbiology at Cardiff University.
"In places in India, Pakistan,
Bangladesh, possibly Russia, Southeast Asia, central South America, we are at
the end game. There's nothing left. And unfortunately there is nothing in the
against overuse of antibiotics
Resistance to drugs emerges through changes
in the bacterium's genetic code – altering the target on its surface to which
antibiotics would normally bind, making the germ impenetrable or allowing it to
destroy or "spit out" the antibiotic.
These super-germs triumph through Darwinian
pressure, helped by humans.
The wrong antibiotics, taken for too short
a period, in too low a dose or stopped to early, will fail to kill the altered
Instead, the drugs will indiscriminately
damage other bacteria and give the resistant strain a competitive advantage –
allowing it to dominate and spread.
Wrong use of antibiotics
At the base of the problem is doctors
prescribing antibiotics wrongly or unnecessarily, and the ease with which
medicines can be obtained without a script in some parts of the world,
including Asia and Africa.
As much as 70% of antibiotics are given for
viral infections, against which they are wholly ineffective, the experts say.
Then there is the problem of farmers in
countries like the United States adding antibiotics to animal feed to help
herds grow faster.
Compounding all of this is the rise in
global travel – a boon for bacterial spread, and a sharp drop in antibiotics
development blamed on a lack of financial incentives for the pharmaceutical
return to the pre-antibiotic era?
The World Health Organisation (WHO) says
drug resistance "threatens a return to the pre-antibiotic era".
"Many infectious diseases risk
becoming untreatable or uncontrollable," it states in a factsheet on
becoming resistant to antibiotics
A case in point: some 450 000 people
resistant (MDR) TB in 2012 and 170 000 died from it. MDR TB does not
respond to the most potent TB drugs – isoniazid and rifampin.
Nearly 10% of MDR cases are thought to be
of the even deadlier XDR (extensively drug resistant) variety which does not
respond to a yet wider range of drugs.
Like other drug-resistant microbes, MDR and
XDR TB can be transferred directly between people – you can get it even if you
have never taken antibiotics in your life.
"Antibiotic resistance is an emerging
disease and a societal problem. The use you can make of an antibiotic depends
on the use made by others," said Courvalin.
Another worry for health planners today is
the spread of a multi-drug resistant strain of the bacterium Klebsiella
pneumoniae – a common cause of infections of the urinary tract, respiratory
tract and bloodstream, and a frequent source of hospital outbreaks.
In some parts of the world, only the
carbapenem antibiotics class remains effective, but now signs are emerging of
resistance even to this last line of defence.
Antibiotics are thought to have saved
hundreds of millions of lives since Alexander Fleming first discovered
penicillin in 1928.
But even Fleming's own warnings of
impending drug resistance went unheeded, and now scientists say people may
start dying from infections like meningitis and septicaemia that are eminently
antibiotics could combat resistance
"If we keep going like this, the vast
majority of human bacterial pathogens will be multi-resistant to
antibiotics," said Courvalin.
The answer? Prudent drug use – better and
faster diagnosis to determine whether an infection is viral or bacterial and
whether it is even susceptible to treatment.
Farmers must stop feeding antibiotics to
their livestock, and hospital and individuals improve their hygiene to prevent
Yet few experts believe the damage can be
"The bugs have become very
sophisticated, they've become very complex," said Walsh.
"You can decrease resistance or reduce
it, but never completely reverse it."
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