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Antibiotic Resistance Becoming Global 'Crisis'

By Tom Rayner, South East Asia Correspondent

Doctors in Thailand have told Sky News they are seeing a worrying growth of antibiotic-resistant infections - with some warning of a "collapse of the modern medical system" if urgent action is not taken.

It comes as health ministers from across Asia prepare to present a new regional action plan to G7 leaders when they meet in Japan later this month.

Overuse of antibiotics globally is believed to be accelerating the mutation and spread of bacteria that are resistant, severely reducing the effectiveness of the drugs that transformed medicine when discovered nearly 90 years ago.

At a children's hospital in Bangkok, associate professor of paediatrics Dr Warunee Vandepitte told Sky News that each month she is seeing children die from infections that until recently have been treatable.

"We really need everyone to get involved to prevent this crisis," she said.

"Because if we don't do anything about this, we will have a collapse of the modern medical system.

"You will no longer have intensive care available, you cannot have transplants, you cannot have surgical management.

"Even caesarean sections could become a life sentence - because if you open up the body you need antibiotics to prevent infections during surgery."

Researchers say the problem of anti-microbial resistance is particularly acute in India and China, but is also prevalent throughout South East Asia - and in a globalised world, drug resistant infections are extremely difficult to contain.

Thailand already invests significant amounts of public money in awareness campaigns about the dangers of over-use of antibiotics, as well as research into the kind of resistance that is being encountered in patients.

But despite government plans to tackle the problem being in place for years, doctors warn the continued sale of antibiotics over the counter without prescription increases the risk of improper use, and bacteria mutating.

Dr Kumthorn Malathum, an infectious disease specialist from Ramathibodi Hospital in Bangkok, said: "Instead of two pills they take one pill.

"This is worse than taking two days instead of five days because you take lower than the normal amount required to kill off the bacteria, so that makes the bacteria resistant to the drug you are taking."

The president of the Infectious Diseases Association of Thailand, Dr Terapong Tantawichien, told Sky News he believed over-the-counter sales should be banned, and underlined the need for continued public awareness across the board.

"People in Asia want to get the drug that will cure the illness, and that often means antibiotics," he said.

"When they go to the doctor or the drugstore, they want to get antibiotics, but we have to educate our people about antibiotic use."

As well as human over-consumption, the use of antibiotics in animal feed has been identified as a major issue.

About 70% of antibiotics produced globally are believed to be used in animal rearing for meat.

Dr Chanwit Tribuddharat runs a laboratory that examines samples of resistant bacteria in an effort to determine the origin.

He says there are growing signs that consumption of food contaminated with antibiotic-resistant bacteria is having an impact on humans.

"Everywhere in the world they (farmers) will give some antibiotics as a feed supplement to keep the animal healthy, but they do not foresee the problem behind it," he said.

"The animal may become the carrier of resistant bacteria … then there may be contamination of the antibiotic-resistant bacteria into the food chain."

In Thailand, scientists have estimated that anywhere between 10,000 and 35,000 deaths each year are the result of antibiotic-resistant infections.

In countries such as India and China, the numbers are thought to be higher still.

The global threat of antibiotic resistance was recently highlighted by Chancellor George Osborne at a meeting of the International Monetary Fund in New York, where he said by 2050 it could kill more people than cancer.

Mr Osborne warned it was an economic as well as a public health threat, and urged drug manufacturers to work to develop new antibiotics with greater urgency.

But Dame Sally Davies, chief medical officer for England, told Sky News the industry is not doing anywhere near enough.

"The industry has stopped investing in it because they don't see that they'd generate enough profit from it," she said.

"This is a global problem. Global travel moves the issue around. It will need a global solution.

"But it's not a one off. We need new antibiotics now, and our children will need new antibiotics, and then our grandchildren. This is with us forever."

Important Health News

Short Answers to Hard Questions About Antibiotic Resistance

By SABRINA TAVERNISE, ERICA GOODE and DENISE GRADY. MAY 27, 2016

The idea of people dying from infections that were once easily cured may seem outlandish. But it is happening already — taking about 23,000 lives in the United States a year — and experts warn that things will get worse because bacteria are becoming resistant to antibiotics faster than we can make new drugs to fight back.

We have ourselves to blame, for overusing the drugs in people and squandering them on livestock. Now, a dangerous form of drug resistancehas reached the United States, leaving us just one step away from infections that are completely untreatable.

What is antibiotic resistance?

It used to be that infectious diseases were the biggest killers of Americans — illnesses like tuberculosis and pneumonia. The invention of antibiotics, which were developed for medical use in the 1940s, changed all that. But they became overused, and the bugs they were invented to fight started to develop ways of resisting them. For some years now, infectious disease doctors have been warning that unless we rein in use of antibiotics in both people and livestock, there will come a day when they will be powerless against the most ferocious bugs, turning the clock back to the early years of the 20th century.

What is CRE?

CRE, which stands for carbapenem-resistant Enterobacteriaceae, is the most fearsome family of germs because it is resistant even to last-resort antibiotics.

The only drug that reliably treats CRE is colistin, an old and inexpensive drug that came on the market more than 50 years ago. This week researchers reported that they had discovered a gene in a bacteria that makes bugs resistant to colistin. It was found in a strain of E. coli in the urine of a patient in Pennsylvania. The patient was successfully treated, but if that gene makes its way into a strain of CRE, the bug would be unstoppable.

“We depend on colistin for the worst of the worst,” said Dr. James Johnson, a professor of medicine and an infectious disease expert at the University of Minnesota. “If it is knocked out, in most cases we really have nothing.”

Should I be scared?

Not yet. The discovery does not mean that an otherwise healthy person with a urinary tract infection is in danger of dying from it. (The Pennsylvania woman eventually recovered because her infection was treatable with antibiotics.) But the gene is mobile and can be picked up by other bugs — in sewer systems, in animal feed lots, in people’s guts or urinary tracts. That can make more bugs more resistant. The biggest worry is that a strain of CRE will pick up the gene. That could be devastating for anyone who is suffering from a CRE infection. “That is the combination we are all afraid of,” said Dr. Lance Price, a researcher at George Washington University.

For now, CRE is rare. The CRE germs cause about 600 deaths a year, usually strike people receiving medical care in hospitals or nursing homes, including patients on breathing machines or dependent on catheters. Healthy people are rarely affected.

How has antibiotic resistance changed medicine?

Dr. Johnson from Minnesota says the spread of resistant bugs means doctors are having to blast patients’ infections with increasingly stronger antibiotics. That has led to more patients coming in with infections caused by the C. difficile, a gut germ that flourishes when the patient has taken a lot of antibiotics. (The germ was estimated to cause almost half a million infections in the United States in 2011, and 29,000 people died within 30 days of the initial diagnosis.) Doctors now frequently send patients home with setups for intravenous antibiotics because pills no longer do the trick. Sometimes the specter of resistant infections can delay or cancel surgeries.

Why aren’t there more new antibiotics?

Most drug companies are not eager to make them. Compared with other drugs, antibiotics are not big moneymakers, and some manufacturers have gotten out of the business. Most people take antibiotics just once in a while, for a short time — unlike drugs for blood pressure, high cholesterol ordiabetes, which most patients will take every day for the rest of their lives. When a new antibiotic comes out, doctors may hesitate to prescribe it, wanting to keep it in reserve for tough infections that older drugs cannot cure. Once the drug gets more widespread use, germs may become resistant to it, and doctors will quit prescribing it. So an antibiotic that required lots of time and money to develop may have a short life on the market. Infectious disease experts are working with Congress and the Food and Drug Administration to try to find ways to create financial incentives for drug companies to invest in making new antibiotics.

Is there anything I can do to protect myself?

A few simple steps can help reduce your risk of picking up a dangerous bug, says Dr. Brad Spellberg, chief medical officer for Los Angeles County+USC Medical Center. Wash your hands frequently. If you get sick, try not to use antibiotics. “What you should be doing is saying to the doctor, ‘Do I really need these antibiotics?’ ” he said.

Since hospitals are incubators of dangerous germs, if you end up in one, try to get out as fast as you possibly can. As for whether to avoid meat raised with antibiotics, Dr. Spelling says there is some evidence that such meat is more likely to have resistant germs, but those are avoidable with proper cooking.

Is there any real harm in taking an antibiotic for a cold?

There are several risks. An important one is based on the fact that healthy people normally carry billions of bacteria in their noses, throats, skin, genitals and gut. Antibiotics change the balance of those microbes, killing off susceptible ones and allowing drug-resistant ones to flourish. Even after a person finishes a course of antibiotics, the excess of drug-resistant bacteria can persist for months. If those drug-resistant bacteria find their way into the urinary tract — and normal gut bacteria are a common source of urinary infections — they can cause a drug-resistant infection that may be difficult to treat. In addition, people constantly pass bacteria — including drug-resistant ones — to their close contacts, so they may put others at risk.

Why are antibiotics given to livestock?

The vast majority of antibiotic use in the United States is in livestock —cows, pigs, chickens, sheep, even farmed fish — either for medical reasons, like treating or preventing disease, or to promote growth. Most of the antibiotics used for humans are also used for livestock, said Dr. Karin Hoelzer, a veterinarian and microbiologist at the Pew Charitable Trusts, who has extensively studied antibiotic resistance.

Antibiotics are believed by many in the food production industry to promote overall health, increasing the number of animals that can be sold for food and improving the quality of the meat.

How can the use of antibiotics in animals pose a risk to humans?

There are several ways. The genes that produce resistance to antibiotics can be easily transferred between bacterial species. So resistant bacteria can pass their resistance to other strains.

Humans can come in contact with resistant bacteria through eating insufficiently cooked meat or other food products: Manure from animals fed antibiotics is commonly used as fertilizer for crops. Farmworkers and people who work in slaughterhouses may also come in contact with the bacteria, providing an opportunity for genes to be exchanged.

Have bacteria resistant to the antibiotic colistin been found elsewhere?

Colistin-resistant bacteria have been found in humans or livestock in countries on every continent, including China, Malaysia, South Africa, Egypt, Italy and several South American nations. Scientists have also reported finding colistin resistance in CRE in some countries, said James Spencer, a senior lecturer in microbiology at Bristol University in England who was a co-author on a 2015 study that reported for the first time finding the colistin-resistance gene in a form that could be easily transferred to other bacteria. The study looked at the presence of the gene in food animals in China.

Has the Food and Drug Administration regulated the use of antibiotics in agriculture?

Under F.D.A policies that will take effect Jan. 1, antibiotics that are considered “medically important” for humans will no longer be approved for use to promote growth in livestock.

The policies also require that a veterinarian supervise the use of antibiotics in feed or water for livestock. Currently, many of the drugs are sold over the counter and do not require the involvement of a veterinarian.

Compliance is voluntary. But the 25 drug companies that manufacture about 283 antibiotics approved for use in livestock have all agreed to change their drug labels to reflect the requirements.

Some critics, however, say they are concerned that the new policies will leave loopholes that could allow food producers to circumvent them.

Health Tips

Can an apple a day really keep the doctor away?

Health tip by Cold Alert ! -- also broadcasted on KOMO Newsradio 1000 AM & 97.9 FM on LifeBeat.

Trying to lose weight, but not having much success? Is your hair and skin dry? Are your joints painful and swollen? Do you often get sick? You might be low in vitamin C.

Vitamin C is important for proper growth and repair of tissue in all parts of the body. It is necessary to form collagen, essential for wound healing, and maintenance of healthy bone, teeth and cartilage.

Your body does not make or store Vitamin C. A typical man needs 90 mg a day, a women 75 mg. Fruits and vegetable are loaded with vitamin C:

one orange = 82 mg

1 cup of papaya = 88 mg

1 cup strawberries = 84 mg

one apple = 8 mg to 29 mg (depends on size and type).

So be sure to get your daily does of Vitamin C and stay healthy!