Special Feature

When drugs don’t work

Posted on March 20, 2015

IN APRIL OF 2014, the World Health Organization (WHO) released a report titled “Antimicrobial Resistance: Global Report on Surveillance” that validated a long-held fear: antibiotic resistance is a threat that puts everyone everywhere at grave risk.

“A post-antibiotic era -- in which common infections and minor injuries can kill -- far from being an apocalyptic fantasy, is instead a very real possibility for the 21st century,” Dr. Keiji Fukuda, WHO assistant director-general for health security, says in the foreword of the report.

The report, which probes antibacterial resistance in particular, says that “very high rates of resistance” are extant in all the regions covered by WHO. It documents antibiotic resistance in nine strains of bacteria that cause common diseases, such as sepsis, diarrhea, pneumonia, urinary tract infections and gonorrhea.

Some of the report’s key findings are a great cause for concern. Klebsiella pneumoniae, an intestinal bacterium that causes hospital-acquired infections, is found to be resistant to carbapenems, a class of antibiotics used to treat life-threatening infections caused by the bacterium. Resistance to fluoroquinolones, which are used for the treatment of urinary tract infections produced by Escherichia coli, is prevalent, putting limitations on the available oral treatments.

“Patients with infections caused by bacteria resistant to a specific antibacterial drug generally have an increased risk of worse clinical outcomes and death, and consume more health care resources, than patients infected with the same bacteria not demonstrating the resistance pattern in question,” the report notes.

This threat to public health can be traced to the inappropriate use of antibiotics in humans and animals. “Misuse has led to the decreased effectiveness of antibiotics because of the emergence of bacteria that are resistant to them,” Stuart B. Levy, writes in his book, The Antibiotic Paradox. “Antibiotics, like other pharmaceuticals, ‘suffer’ from present-day reliance on medication to cure every ailment, the ‘pill for every ill’ belief,” he says.

“The misuse of antibiotics becomes a greater threat when combined with the forces of globalization. Global trade, travel, migration and medical tourism can spread resistant pathogens into every corner of the world in a matter of days,” Dr. Shin Young-soo, WHO regional director for the Western Pacific, said in a statement.

The pharmaceutical companies may also be faulted: they are not creating more antibiotics because such undertaking is not sound. Producing drugs that cure chronic illnesses is more profitable, for these drugs are taken more frequently. According to a 2011 analysis of the United Kingdom’s (UK) Office of Health Economics, an antibiotic has a net present value (NPV) of -$50 million, while a musculoskeletal drug has an NPV of +$1 billion.

A grim future awaits humanity if no immediate and systematic action is taken. A research published in the UK in 2014 paints a staggering picture: 300 million people would die a premature death because of drug resistance in the next 35 years while the world would lose between $60 trillion and $100 trillion worth of economic output.

The WHO report remarks that the tools to tackle antibiotic resistance, such as the basic systems to track and monitor the problem, show gaps or are nonexistent in many countries. Furthermore, it states that there is an “urgent need to strengthen collaboration on global AMR (antimicrobial resistance) surveillance.”

Apart from a coordinated global effort to keep an eye on AMR, “WHO is also calling attention to the need to develop new diagnostics, antibiotics and other tools to allow health care professionals to stay ahead of emerging resistance,” according to a news release.

The Philippines, for its part, has begun to respond to the growing threat of antibiotic resistance. Last October, the Food and Drug Administration, via a memorandum circular, has obliged all drugstores to display infomercials about antibiotic resistance.

President Benigno S. C. Aquino III, in April 2014, signed Administrative Order No. 42 to create an interagency committee, co-chaired by the Department of Health and the Department of Agriculture, to formulate and implement a national plan to combat antimicrobial resistance in the Philippines. -- Francis Anthony T. Valentin