7 May 2014

Africa: A 'Post-Antibiotic Era' May Be Approaching, Warns WHO

Antimicrobial resistance threatens to make a wide range of drugs for common diseases such as pneumonia, diarrhoea, malaria and tuberculosis increasingly toothless, and poor surveillance networks are hindering response efforts, a UN report finds.

Better analytical laboratories and healthcare systems are essential, particularly in low- and middle-income countries, to fill the significant data gaps on the characteristics and distribution of drug-resistant pathogens, according to the WHO's first antimicrobial resistance (AMR) report, published last week (30 April).

A clearer picture would allow decision-makers to identify resistance hotspots and tailor treatment programmes, making them more effective for patients and minimising the risk of spreading resistance, it says.

Improving the often limited monitoring capacity of low-income regions was "absolutely critical" to allow the global health community to respond to AMR, says Carmem Pessoa-Silva, team leader for the WHO's AMR effort.

"Major gaps in surveillance must be filled if we are to be informed about the spread of new resistant pathogens and therefore determine the need for new diagnostics and treatment options," she tells SciDev.Net.

The report compiles data from 114 countries focused on the prevalence of AMR in nine common yet potentially deadly bacteria responsible for illnesses, including pneumonia and diarrhoea. It also investigates other diseases with a high burden in the developing world, such as malaria, TB and HIV.

"Very high rates" of antibiotic resistance are present in all regions, the report finds. And nearly seven per cent of HIV cases exhibit resistance and 3.6 per cent of all new TB cases are multi-drug resistant - requiring a complex cocktail of drugs that is often too expensive for low-income countries.

While resistance rates vary geographically, the overall situation has reached "alarming levels", raising the chances that widespread medical conditions will become increasingly deadly, it says.

"A post-antibiotic era - in which common infections and minor injuries can kill - far from being an apocalyptic fantasy, is instead a very real possibility for the twenty-first century," the report says.

Despite the gravity of the situation, a "scarcity of accurate and reliable data on AMR" is preventing the systematic monitoring of trends that would allow the evaluation and adaptation of efforts to contain resistant forms, the report finds.

For example, only 49 per cent of countries in Africa and 32 per cent of those in the Eastern Mediterranean region - including the Middle East, North Africa and parts of Central Asia - provided data sets for the nine bacteria the report studied.

This paucity of data is a reflection of weak healthcare systems that cannot accurately identify infections, as well as a lack of laboratories needed for diagnosis and treatment, says Pessoa-Silva.

A similar concern that inadequate laboratory capacity could be boosting resistance was raised by a study published last month on the quality of antimalarial drugs distributed worldwide.

Accurate information on AMR can also help spur the development of desperately needed replacements for antimicrobial drugs, says Ruth McNerney, a TB specialist at the London School of Hygiene & Tropical Medicine, United Kingdom.

It strengthens advocacy efforts to encourage pharmaceutical companies to focus resources on developing new antibiotics, which tend to be relatively unprofitable, as well as allowing producers to better meet demand, she says.

As many policymakers follow the WHO's lead, the report is an important step in raising the profile of the problem - which has been known for a long time yet generated little action, says McNerney.

"The WHO is behind the curve on this, so it is great to see that they are finally waking up to this issue," she tells SciDev.Net.

Link to the full report

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