Prosperous People Are Helping Bugs in Their Fight Against Ourselves

Antibiotics. Credit: oliverdodd/Flickr, CC BY 2.0

Credit: oliverdodd/Flickr, CC BY 2.0

The Centre for Disease Dynamics, Economics and Policy (CDDEP), a public-health think-tank out of Washington DC and New Delhi, has warned of alarmingly high rates of bacteria resistance to antibiotics that can lead to life-threatening infections around the world. Though wealthy countries still use far more antibiotics per capita, high rates in the low and middle income-income countries (where surveillance data is now available—such as from India, Kenya, and Vietnam) sound a warning to the world, the latest data shows.

In India, 57% of infections caused by Klebsiella pneumoniae, a dangerous superbug found in hospitals, were resistant to one type of antibiotics in 2014, which is up from 29% in 2008. These drugs are known as carbapenems and are ineffective against Klebsiella infections in 20% of cases in the United States and under 5% of cases in most of Europe. The bug is also some 80% resistant to third generation cephalosporins, 73% to fluoroquinolones, and 63% to aminoglycosides.

Similarly, E. coli resistance is high and going up for many drug types and in many regions across the globe. However, compared to all other countries, India is said to have the highest rates of resistance to nearly every drug used to treat it. Strains of E. coli are more than 80% resistant to three different classes of drugs. In simple terms, treatment options are running out.

The authors of the latest report, ‘The State of the World’s Antibiotics, 2015‘ (PDF), recommend six ways to check the spread of antibiotic resistance. While antibiotic stewardship was the key factor according to the authors, they also said the problem of antibiotic resistance hasn’t been the lack of new antibiotic drugs but irrational use of the existing ones.

The findings on antibiotic resistance were released through an interactive online tool that allows users to track the latest global trends in drug resistance in 39 countries, and antibiotic use in 60 countries. Dubbed ResistanceMap, it includes infections caused by 12 common and potentially deadly bacteria including E.coli, Salmonella, and methicillin-resistant Staphylococcus aureus (MRSA).

Antibiotic resistance of E. coli in India. Source: ResistanceMap

Antibiotic resistance of E. coli in India. Source: ResistanceMap

Introduced in the 1940s, antibiotics have been central to modern healthcare across the world. They’re used widely for treating and preventing acute infections, protecting patients during surgical procedures and on people with compromised immune systems. Increasingly, they’ve also been used to treat livestock – but at times indiscriminately enough to warrant concerns of encouraging antibiotic resistance. So while existing antibiotics are becoming increasingly ineffective, new variants are being pushed beyond the reach of those who need them the most.

According to the report, between 2000 and 2010, the total global antibiotic consumption went up by more than 30%, from approximately 50 billion to 70 billion standard units. While per capita consumption is generally higher in high-income countries, the greater increase in antibiotic use between this decade was in low and middle income countries.

The report also says that 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 prescriptions. Most community use is usually inappropriate, being taken for coughs and colds, a treatment that’s ineffective and only adds to the burden of resistance.

Similarly, in 2010, at least 63,200 tons of antibiotics were consumed by livestock around the world. Bt 2030, this figure is expected to rise by two-thirds to 105,600 tons, to meet the demands of an estimated 8.5 billion people who will inhabit the planet, the report’s authors warn. In turn, two-thirds of the projected increase is accounted for by an increase in the number of animals raised for food production and the remaining by the shift from small-scale to industrial-scale production.

“We are 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,’’ says Sumanth Gandra, an infection diseases physician and CDDEP Resident Scholar in New Delhi.

The incidence of methicillin-resistant Staphylococcus aureus (MRSA), a highly dangerous pathogen that people can contract in the community and in hospitals, is also rising in sub-Saharan Africa, India, Latin America and Australia. In fact, estimates published in the report show that about 90% of MRSA was resistant to multiple antibiotics in 2013 in Latin America.

ResistanceMap also tracks rates of antibiotic use, and findings indicate that both human and animal antibiotic use is rising dramatically in middle-income countries, particularly in China, India, Brazil and South Africa. Per capita use in these countries is still less than half of what it is in the United States but the increase, driven by growing prosperity, includes a great deal of unnecessary and inappropriate use.

“A rampant rise in antibiotic use poses a major threat to public health, especially when here is no oversight on appropriate prescribing,’’ says Ramanan Laxminarayan, Director of the CDEP and co-author of the report. “Antibiotic use drives antibiotic resistance,” Dr. Laxminarayan remarked, adding that humankind will need to focus 80% of our global resources “on stewardship and no more than 20% on drug development”.