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Post-antibiotic world almost upon us

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The World Health Organisation has warned that humanity is headed for a post-antibiotic era in which even minor injuries and infections could be deadly unless nations, groups and individuals begin immediately to work together to track medicine use and resistance.

In its first global assessment of antibiotic resistance, the WHO has found that in large parts of the world commonly used antibiotics have been rendered virtually useless, meaning that for the first time in generations many people face the risk of dying from infections and injuries that would have been considered minor for their parents or grandparents.

“Without urgent, coordinated action by many stakeholders, the world is headed for a post-antibiotic era in which common infections and minor injuries which have been treatable for decades can once again kill,” WHO Assistant Director-General for Health Security Dr Keiji Fukuda said.

The WHO survey of 114 countries discovered antibiotic resistance has spread alarmingly and was now a feature in most regions of the world.

The agency revealed that resistance to cabapenem antibiotics – considered the treatment of last resort for infections caused by the common intestinal bacteria Klebsiella pneumonia – is now found in every region of the world. This is particularly concerning because K. pneumonia is a major cause of hospital-acquired infections including pneumonia and sepsis.

In some countries, the WHO found, resistance has meant that carpabenem antibiotics were not effective in more than half the patients being treated for K. pneumonia infections.

Resistance to one of the most common treatments for urinary tract infections, fluoroquinolones, was also found to be “very widespread”.

Furthermore, Australia’s relative geographic isolation did not confer immunity from these disturbing trends, according to the WHO.

The agency found that the Western Pacific Region, of which Australia is a part, had high levels of E. coli resistance to fluoroquinolones, and there was also widespread resistance by K. pneumonia to third generation cephalosporins.

“In some parts of the Region, as many as 80 per cent of Staphylococcus aureus infections are reported to be methicillin-resistant (MRSA), meaning that treatment with standard antibiotics does not work,” the WHO reported.

In addition, it named Australia as among a handful of countries including Japan, the UK, France and Canada, where the last resort treatment for gonorrhoea – third generation cephalosporins – had failed.

Earlier this year, AMA President Dr Steve Hambleton warned of the threat posed by drug-resistant bacteria, including those carried by travellers infected while overseas.

“No longer do our borders protect us from multi-resistant organisms,” Dr Hambleton said. “These are a major threat to our health system, so it does mean that we need to engage internationally to act on multidrug resistance.

“We simply do not have a new antibiotic up our sleeve to treat some of these conditions.”

The WHO said its report would be used to kick-start a global effort, led by it, to address drug resistance, including the development of shared tools and standards, and better international collaboration to track drug resistance, measure its impact, and design effective solutions.

In the Western Pacific Region, the WHO said it would reinvigorate region-wide networks to track antibiotic resistance that had been established in the 1980s but had since withered.

In addition, it has urged patients to use antibiotics only when and as prescribed, and has called on health professionals to be diligent in applying infection control measures, and only to prescribe and dispense antibiotics when they are truly needed.

Dr Fukuda warned that “unless we take significant actions to improve efforts to prevent infections and also change how we produce, prescribe and use antibiotics, the world will lose more and more of these global public health goods, and the implications will be devastating”.

Adrian Rollins