TACKLING DRUG-RESISTANT INFECTIONS GLOBALLY FINAL REPORT AND RECOMMENDATIONS

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1.
THE PROBLEM: WHY TACKLING AMR IS ESSENTIAL
What is antimicrobial
resistance (AMR)?
Antimicrobial drugs are medicines that are active against
a range of infections, such as those caused by bacteria
(antibiotics), viruses (antivirals), fungi (antifungals) and
parasites (including antimalarials).
AMR arises when the micro-organisms which cause infection
(e.g. bacteria) survive exposure to a medicine that would
normally kill them or stop their growth. This allows those
strains that are capable of surviving exposure to a particular
drug to grow and spread, due to a lack of competition from other
strains. This has led to the emergence of ‘superbugs’ such as
Methicillin‐resistant Staphylococcus aureus (MRSA) and extremely
drug‐resistant tuberculosis, bacteria which are difficult or
impossible to treat with existing medicines.
Resistance to antimicrobials is a natural process that has
been observed since the first antibiotics were discovered –
and, indeed, the genes that confer drug resistance upon some
strains of bacteria pre-date antibiotics by millions of years.
However, AMR has increasingly become a problem in recent
times because overuse of antimicrobials has increased the rate
at which resistance is developing and spreading, but we lack
new drugs to challenge these new superbugs. This results in us
facing a growing enemy with a largely depleted armoury.
In the past, resistant infections were associated predominantly
with hospitals and care settings, but over the last decade
resistant infections have been seen in the wider community too.
With resistance on the rise, we stand to lose the immense ground
we have gained in the last century. This includes: 1) our fight
against life threatening infectious diseases such as pneumonia,
TB, HIV and malaria; 2) our battle against conditions such as
cancer, where antibiotics are crucial in helping chemotherapy
patients avoid and fight infection; and 3) huge advances in
surgical procedures like organ transplants and caesarean sections,
which have now become routine and relatively low risk, thanks
to our ability to effectively stave off or treat acute infections
with antibiotics.
Drug-resistant infections already cost
too many lives today
We estimated in our first report, published in December 20141,
that in total about 700,000 people die every year from drugresistant
strains of common bacterial infections, HIV, TB and
malaria. This number is likely to be an underestimate due to
poor reporting and surveillance. Nearly 200,000 people die
every year from multidrug-resistant and extremely drugresistant
tuberculosis (TB) alone2. In India, antibiotic-resistant
neonatal infections cause the deaths of nearly 60,000 new-borns
each year3. A current death toll on this scale means that more
than one million people have lost their lives to drug-resistant
infections in the 19 months since we published our first report.
Our ability to cure infections that were once considered benign
is already damaged. For instance, the rapid development of
drug-resistant strains of gonorrhoea combined with the fact
that we do not have a rapid diagnostic test to guide doctors’
choice of prescription, means we are down to using our ‘last line’
antibiotic to treat gonorrhoea4. After this antibiotic fails, there
are no more treatment options on the shelf. For other infections,
doctors running out of better options are using antibiotics that
were once avoided due to their bad side effects. This is the case
with colistin, for example, which can cause kidney failure and so
was never given to patients for many years. Over the past decade
however, it has re-entered use as a last resort treatment for
patients with particularly hard-to-treat Gram-negative bacterial
infections5, and already colistin resistance is emerging.
The economic impact is also already material. In the US alone,
more than two million infections a year are caused by bacteria
that are resistant to at least first-line antibiotic treatments6,
costing the US health system 20 billion USD in excess costs
each year7.
1 Review on AMR, Antimicrobial resistance: Tackling a crisis for the health and wealth of
nations, 2014.
2 WHO, Tuberculosis Factsheet, Online, Available at: http://www.who.int/mediacentre/
factsheets/fs104/en/
3 Laxminarayan R, Duse A, Wattal C, Zaidi AKM, Wertheim HFL, Sumpradit N, et al.
Antibiotic resistance – the need for global solutions, The Lancet Infectious Diseases
2013; 13: p.1057-98.
5 Boucher HW, Talbot GH, Bradley JS, Edwards JR Jr, Gilbert D, Rice LB, et al. Bad bugs,
no drugs: no ESKAPE! An update from the Infectious Diseases Society of America,
Clinical Infectious Diseases, 2009; 41, 1-12.
6 Centres for Disease Control and Prevention, Antibiotic Resistant threats in the United
States, 2013, US Department of Health and Human Services.
7 Smith R, Coast J, The true cost of antimicrobial resistance, BMJ, 2013, 346, f1493.
4 Davies SC. Annual report of the Chief Medical Officer 2011: Volume 2. London: UK
Department of Health. 2013.