A number of press reports have appeared, mainly in the UK,
talking about Jim O’Neill’s predictions on the effect of massive resistance to
antibiotics among common human pathogens.
I’m sure this is done to justify, at a later time, the kind of money
O’Neill is going to be asking government(s) to spend to support research on
antibiotic resistance and the discovery and development of new antibiotics. I
am of the opinion that these dire predictions are unrealistic and exaggerated –
the word “hype” comes to mind. On the other hand, no one should doubt the
public health threat of emerging resistance.
We are constantly reminded that antibiotic resistance is not
just a problem in hospitals. Recent experience in the US is a good
example. According
to the US CDC, the common GI
pathogen, Shigella, which causes severe diarrhea, frequently bloody, has become
resistant to the antibiotic most often used to treat the infection, ciprofloxacin.
Shigella is estimated to cause about 500,000 cases of illness every year in the
US alone and something like 100 million cases a year worldwide. Using molecular
methods, the CDC identified a cluster of 243 cases of Shigella infection
stretching from Massachussetts to California. Of the 109 isolates that tested
by public health agencies, 87 were resistant.
22% of infected patients were hospitalized. The CDC showed clearly that,
unlike in years past, these resistant strains can be acquired right here in the
US – no travel is necessary.
It is important to remember that most cases of Shigellosis
will resolve without antibiotic therapy.
But occasional cases are more severe and require therapy or even
hospitalization. The emergence of resistance to the most commonly used
antibiotic to treat these infections right here in the US is an important
warning. Its time to get our house in order.
Shigella can be a foodborne pathogen and can be transmitted
from person to person via the fecal oral route. The origin of Shigella in food
is human or animal excrement or the use of contaminated groundwater for
watering or irrigation.
It is also important to remember that our
food supply is now global. 20% of food consumed here in the US is now
imported. 70% of seafood and 35% of
fresh produce is imported. So not only do we have to pursue rational antibiotic
policies for food here in the US, but we also need to partner with other countries
who export their food to the US.
To keep ahead of this emerging resistance, many steps are
required. Reduction of the unnecessary
use of antibiotics for animals, crops and for us human beings is clearly
required. This also means being able to
monitor antibiotic use and the appropriateness of such use. We have
not been very good at as yet – especially on the animal/crop side of things. We're also not good at tracking human antibiotic use. We could do a better job in hospitals and we are terrible in outpatients and in chronic care facilities.
We need to approach the entire food supply issue on a global scale. We’re not so good at this either.
We need to approach the entire food supply issue on a global scale. We’re not so good at this either.
We also need a constant pipeline of new antibiotics. To achieve this we need to stop the loss of
antibiotic discovery and development within the pharmaceutical industry –
especially among the larger companies that can drive such work at smaller
companies and within academia. This will
require two things; money and training. The world is sadly lacking both of these
when it comes to antibiotics and the US and the UK are not exceptions to this
rule. Like I keep saying - show me the money!
No comments:
Post a Comment