Antibiotic Resistance: The Need For a Global Strategy

Abstract

The development of antibiotic resistance is a major problem for mankind and results in fatal consequences on a daily basis across the globe. There are a number of reasons for this situation including increasing globalization with worldwide travel, health tourism, over use and ineffective use (both in man and animals), and counterfeiting of the antimicrobial drug products we have available currently. Although there are huge economical, demographic, legal and logistic differences among the global communities, there are also differences regarding the best approach to dealing with antibiotic resistance. However, as resistant bacteria do not respect international borders, there is clearly a need for a global strategy to minimize the spread of antibiotic resistance, to optimize the use of antibiotics, and to facilitate the development of new and effective medications. This commentary provides an insight into the issues and some of the ongoing programs to ensure an effective treatment for the future.

Introduction

History tells us that the globalization and the expansion of trading networks will inevitably lead to more rapid spread of disease and facilitate global pandemics. Infectious diseases have always followed the main arteries of global trade. Plague was distributed by European merchant traders throughout the 17th century. The slave trade triggered several large outbreaks of yellow fever in America in the 19th century. Global war and the rapid movement of tens of thousands of troops contributed to the last great pandemic of the 20th century, the “Spanish influenza.”¹ Figure 1 shows the death rates per 100,000 persons according to age and indicates that compared to the interpandemic years (1911-1917), not only did the very young and elderly patients show high death rates (which may have been anticipated), but significant numbers of “healthy” adults also died. However, the prevailing wartime conditions were not the only explanations as to why so many people died in 1918, as multiple factors seemed to have played a role based on recent genetic analysis of autopsy material.² Currently, air travel has mostly been responsible for the rapid dissemination of several strains of avian flu, some of which reached pandemic status.³ Woolhouse⁴ reported that global patterns of disease have been evaluated between 1940 and 2004, and 335 emerging disease events have been identified. These could be novel species or strains, including drug resistant variants. Examples include hospital-acquired yeast infections, including different species of Candida, and worryingly, several bacterial infections acquired from animal reservoirs, for example, cat scratch disease, Bartonella henselae. Woolhouse⁴ reported that there may be significant underreporting of these emerging global infectious diseases from other less developed regions in the world. Many emerging pathogenic organisms have a wide range of potential hosts, including mammals and birds. There are calls for international capability to detect, identify, and monitor these newly emerging pathogens, targeting those global regions that require this the most. This would benefit the global health care system. Because of globalization, these emerging diseases are the problem of all—not just the affected country.⁴ In addition, infectious diseases are not standing still, the evolutionary pressures caused by poor antibiotic usage strategies (either inappropriate for the disease to be treated, the treatment stopped prematurely, or antibiotics dispensed or sold in daily packs) has led to an increase in global bacterial resistance.

Furthermore, there is an inequitable distribution of research and development (R&D) activities and funding favoring noncommunicable diseases (NCDs) at the expense of those health problems experienced by people living outside the developing world. This has been termed the 10/90 gap, as 10% of research activities and funding is used to address 90% of the world’s disease burden.⁵ More focus on NCD medicines could be at the detriment of those essential medicines identified by the World Health Organization (WHO) on the essential medicines list.