Antibiotic resistance rates across the globe are alarming, and the only sustainable solutions are to limit overuse and misuse of antibiotics, according to the Centre for Disease Dynamics, Economics & Policy (CDDEP). Medscape reports that the CDDEP and the Global Antibiotic Resistance Partnership have co-released a new report, The State of the World's Antibiotics, 2015, on the state of global antibiotic use and antibiotic resistance in humans and livestock.
The Global Antibiotic Resistance Partnership is a CDDEP project funded by the Bill & Melinda Gates Foundation, which is assisting eight low- and middle-income countries develop local solutions to antibiotic resistance problems while sustaining antibiotic access in South Asia, East Africa, and South Africa.
In addition to the report, CDDEP has developed a new tracking tool that presents the latest global trends in antibiotic use in 69 countries, and drug resistance in 39 countries. "For the first time, we have data on low- and middle-income countries, where antibiotic resistance is a serious problem but rarely the focus of policy solutions," Ramanan Laxminarayan, CDDEP director and report co-author is quoted as saying. "We hope this report, together with the Resistance Map online tool, will help empower these countries to understand the burden of antibiotic resistance in their region and then take coordinated, research-backed action to limit it," he said.
Between 2000 and 2010, total global antibiotic consumption grew by more than 30%, according to the report. In most countries, about 20% of antibiotics are used in hospitals and other healthcare facilities, and 80% are used in the community, either prescribed by healthcare providers or purchased directly by consumers or caregivers without prescription, reports Health-e News. It is estimated that about half of all community use of antibiotics is in appropriate.
Against this background, the report presents an overview of global patterns in antibiotic resistance, the antibiotic research and development pipeline, and finally interventions that can be used to rationalise antibiotics use and slow the development of resistance.
The report commends South Africa for developing a national strategy framework to combat antibiotic resistance and concludes with a number of recommendations, including: reduce the need for antibiotics through improved water, sanitation, and immunisation; improve hospital infection control and antibiotic stewardship, and reduce and eventually phase out sub-therapeutic antibiotic use in agriculture.
South Africa's use of antibiotics soared in the decade to 2010, yet it is doing a much better job than its fellow Brics (Brazil, Russia, India, China) bloc nations at containing resistance to these life-saving drugs, according to the report.
Antibiotic resistance is lower in South Africa than in other Brics countries because the government and the private healthcare sector have taken steps to manage their use, said the centre's local co-ordinator Kim Faure in a Business Day report. Public clinics and hospitals are supplied with a restricted range of medicines, which helps limit antibiotic use. The private sector has developed a programme called the Best Care Always initiative which promotes better infection control in hospitals along with more judicious prescribing by doctors. And patients can only obtain antibiotics from a pharmacy with a prescription. "Many Brics countries don't require a prescription, and you can purchase antibiotics like Smarties," she said in the report.
The centre's report finds Brazil, Russia, India, China and South Africa all reported significant increases in antibiotic use between 2000 and 2010, driven by greater consumption in humans and animals. Antibiotic use rose 68% in Brazil, 19% in Russia, 66% in India, 37% in China, and 219% in South Africa. Together these countries accounted for about three quarters of the total increase in global antibiotic consumption, yet they experienced just one third of the world’s increase in population over this period. Nevertheless, per capita consumption in these countries remains lower than more developed nations such as the US.
The report warns of an alarming increase in bacteria resistant to last-resort antibiotics in many low and middle-income countries. In India, for example, 57% of infections with the hospital super-bug Klebsiella pneumoniae were resistant to carbapenems in 2014, almost double the 29% recorded in 2008. In South Africa, by contrast, carbapenem resistance to K. pneumoniae isolates stood at just 2% in 2013. Carbapenems are still effective against Klebsiella infections in about 90% of cases in the US, and 95% of cases in most of Europe.
"We're seeing unprecedented resistance to these precious antibiotics globally, and especially in India. If these trends continue, infections that could once be treated in a week or two could become routinely life threatening and endanger millions of lives" Sumanth Gandra, an infectious diseases physician and CDDEP resident scholar in New Delhi is quoted in the report as saying.
Faure said in the Business Day report that South Africa also reported less antibiotic resistance for Staphylococcus aureus, a common hospital-acquired infection. Methicillin-resistant Staphylococcus aureus (MRSA) in SA stood at 28% of isolates tested in 2014, down from 34% in 2011. By contrast MRSA in India almost doubled from 29% in 2009 to 47% in 2014.
The University of Cape Town's head of infectious diseases, Marc Mendelson, said the apparent decline in MRSA in South Africa should be treated with caution. "It may well be that the reduction is being led by reductions of MRSA in the private sector, where MRSA screening is undertaken, and that rates of MRSA in public institutions may be considerably higher," he said.Full Medscape report Report Resistance Map Health-e material Full Business Day report