Global Antibiotic Use and Resistance in 'Dire' Situation

Troy Brown, RN

September 18, 2015

Antibiotic resistance rates across the globe are alarming, and the only sustainable solutions are to limit overuse and misuse of antibiotics, according to the Center for Disease Dynamics, Economics & Policy (CDDEP).

CDDEP and the Global Antibiotic Resistance Partnership have coreleased 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 coauthor, said in a CDDEP blog.

"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.

State of the World's Antibiotics

CDDEP says drug conservation should be prioritized over new research and development efforts.

"We need to focus 80 percent of our global resources on stewardship and no more than 20 percent on drug development," said Laxminarayan. "No matter how many new drugs come out, if we continue to misuse them, they might as well have never been discovered."

A major problem with prioritizing drug development as a solution is that new antibiotics cost much more than those that are currently available and are out of reach for those in low- and middle-income countries.

The World Health Organization recently emphasized the need for country-level antibiotic resistance strategies when it endorsed the global action plan on antimicrobial resistance in May 2015. The plan asks all countries to adopt national strategies within 2 years.

The new report features specific recommendations for achieving this goal.

Effective policies include antibiotic stewardship campaigns, hospital infection control, limiting infections by improving vaccination coverage, and reducing the need for antibiotics.

"Our research shows that antibiotic resistance and misuse is a dire — and growing — problem in every country on earth," said Laxminarayan. "The good news is that every country can work on solving it."

Resistance Map

The Resistance Map data address infections caused by 12 common and potentially fatal bacteria, including Escherichia coli (E. coli), Salmonella, and methicillin-resistant Staphylococcus aureus (MRSA).

The tracking tool presents data from low- and middle-income countries including India, Kenya, Vietnam, Thailand, and South Africa. It features line graphs that illustrate trends in antibiotic use and resistance over time, column charts that compare antibiotic use and resistance rates between countries, world maps that compare country-level differences, and subnational maps that compare state and regional variations.

"Though wealthy countries still use far more antibiotics per capita, high rates in the low- and middle-income countries where surveillance data is now available — such as India, Kenya, and Vietnam — sound a warning to the world," according to the CDDEP blog.

"For example, in India, 57 percent of the infections caused by Klebsiella pneumoniae, a dangerous superbug found in hospitals, were found to be resistant to one type of last-resort drug in 2014, up from 29 percent in 2008."

These drugs, known as carbapenems, still work against 90% of Klebsiella infections in the United States and more than 95% of cases in most of Europe.

"Carbapenem antibiotics are for use in the most dire circumstances — when someone's life is in danger and no other drug will cure the infection," Sumanth Gandra, an infectious diseases physician and CDDEP resident scholar in New Delhi, India, said in the blog. "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."

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