http://www.hstoday.us/single-article/who-says-antibiotic-resistance-is-serious-worldwide-threat-to-public-health/eb5821bc088133ab0e17de92f0d699f5.html



*WHO Says Antibiotic Resistance is Serious, Worldwide Threat to Public
Health*

By: Kylie Bull, Managing Editor

06/17/2014 ( 8:30am)

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Are we heading for a post-antibiotic era, where everyday infections become
killers?



The World Health Organization (WHO) thinks we are, and a new report
provides the most comprehensive picture of antibiotic resistance to date,
with data from 114 countries.



The WHO report takes a detailed, global look at antimicrobial resistance
(AMR), including antibiotic resistance, and reveals that this serious
threat is no longer a prediction for the future, it is happening right now
in every region of the world and has the potential to affect anyone, of any
age, in any country.



Antibiotic resistance -- when bacteria change so antibiotics no longer work
in people who need them to treat infections -- is now a major threat to
public health.



Antibiotic resistance causes people to be sick longer and increases the
risk of death. For example, people with MRSA (methicillin-resistant
Staphylococcus aureus) are estimated to be 64 percent more likely to die
than people with a non-resistant form of the infection.



“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,” said
Dr. Keiji Fukuda, WHO’s Assistant Director-General for Health Security.
“Effective antibiotics have been one of the pillars allowing us to live
longer, live healthier and benefit from modern medicine. 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.”



The WHO report, *Antimicrobial Resistance: Global Report on Surveillance*,
noted that resistance is occurring across many different infectious agents,
but it focuses on antibiotic resistance in seven different bacteria
responsible for common, serious diseases such as bloodstream infections
(sepsis), diarrhea, pneumonia, urinary tract infections and gonorrhea. The
results are cause for high concern, documenting resistance to antibiotics,
especially “last resort” antibiotics, in all regions of the world.



Resistance to one of the most widely used antibacterial medicines for the
treatment of urinary tract infections caused by E. coli is very widespread.
In the 1980s, when these drugs were first introduced, resistance was
virtually zero. Today, there are countries in many parts of the world where
this treatment is now ineffective in more than half of patients.



Treatment failure to the last resort of treatment for gonorrhea (third
generation cephalosporins) has been confirmed in Austria, Australia,
Canada, France, Japan, Norway, Slovenia, South Africa, Sweden and the
United Kingdom. More than 1 million people are infected with gonorrhea
around the world every day, making it a ticking time bomb.



The report also includes information on resistance to medicines for
treating other infections such as HIV, malaria, tuberculosis and influenza.
It reveals that key tools to tackle antibiotic resistance -- such as basic
systems to track and monitor the problem -- show gaps or do not exist in
many countries. Other important actions include preventing infections from
happening in the first place through better hygiene, access to clean water,
infection control in healthcare facilities and vaccination to reduce the
need for antibiotics. WHO is also calling attention to the need to develop
new diagnostics, antibiotics and other tools to allow healthcare
professionals to stay ahead of emerging resistance.



The report stated that although most countries in the European Union have
well-established national and international systems for tracking antibiotic
resistance, countries in other parts of the region urgently need to
strengthen or establish such systems. WHO’s Regional Office for Europe and
its partners are supporting these countries through the newly-established
Central Asian and Eastern European Surveillance of Antimicrobial Resistance
network (CAESAR). The aim of CAESAR is to set up a network of national
systems to monitor antibiotic resistance in all countries of the WHO
European Region for standardized data collection so that information is
comparable.



According to research led by the Johns Hopkins Center for a Livable Future,
antibiotic use in food animal production plays a significant role in the
growth of antibiotic-resistant bacteria. In the United States, 80 percent
of antibiotics sold are used in food animal production. Despite decades of
scientific evidence linking such use to antibiotic resistance though,
little has been done to reduce the use of antibiotics in US animal
agriculture. While the European Union maintains tougher standards, current
inconsistencies are cause for great concern during Transatlantic Trade and
Investment Partnership (T-TIP) negotiations. The T-TIP aims to harmonize
regulations between the two markets and remove non-tariff barriers to
trade. Experts suggest, if not properly addressed, the negotiations could
lower European Union antibiotic use standards simply to facilitate trade
with the US -- putting both sides of the Atlantic at risk.



A joint expert consultation in 2003 by WHO, the UN’s Food and Agriculture
Organization / and World Organization for Animal Health concluded that
there is clear evidence of the link between use of antibiotics in food
producing animals and antimicrobial resistance.



Glenn Thomas, media spokesperson for WHO, told *Homeland Security Today*
that the organization has been involved for more than 15 years in the area
of AMR originating from the food chain, and recommends prudent use of
antibiotics in food producing animals, with a special emphasis on
critically important antimicrobials for human health (fluoroquinolones, 3rd
and 4th cephalosporins and macrolides) and a ban on the use of
antimicrobials as growth promoters.



“Alternatives exist,” Fukuda said, “but WHO puts emphasis on the reduction
of the need for antibiotics through improved infection control
(biosecurity, good animal husbandry, vaccination, probiotics, etc.)."



If today’s society is becoming resistant to current antibiotics, isn’t the
solution to simply create new ones? Thomas said this poses a number of
problems.



“It is difficult to find and develop a single ‘magic bullet’ that will be
effective against all types of resistance in all bacteria causing
diseases,” he said.



“Bacterial evolution will make any new antibiotic lose effect after some
time due to development of resistance, so there will be no permanent
long-lasting solution. Thus prevention is crucial and other new treatment
options need to be explored.”



It is scientifically difficult to identify new targets to attack the
bacteria – and time-consuming.



“A normal timeline from discovering a new molecule until a medicine has
been developed and can be prescribed, is usually about 10 years. Under some
‘burning’ conditions, and for short treatments of life-threatening diseases
(as would be the case for special antibiotics), maybe it can be somewhat
shortened,” Thomas said.



It is also, of course, an expensive process, and drugs companies and their
shareholders may prefer that time and money is spent discovering and
producing more lucrative products.



Antibacterial resistance is everywhere, and can affect anyone at any age in
any place.



“It is true that some countries/regions which have focused on the
containment of AMR for many years seem to have lower proportions of
resistance in some of the investigated bacteria, and it is important that
experiences from these regions are shared and adapted to be implemented
elsewhere,” Thomas said.



WHO is supporting information sharing by developing tools and providing
guidance. Many areas of the world have established networks to record and
monitor AMR and develop solutions. In Latin America, the United States and
Canada there is a surveillance network called ReLAVRA, which has been
operating for several years. Collaboration with English-speaking areas of
the Caribbean is currently in progress. Another Pan-American network called
SIREVA is carrying out surveillance on bacteria causing meningitis.



While heads of state focus their attentions on counter terrorism
strategies, it is absolutely vital that the public health threats to
security, such as the very real problem of antibiotic resistance, are not
allowed to creep through the back door.




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