World is losing battle against drug resistance, warns WHO

[LONDON] A "post-antibiotic" era, in which many common infections no longer have a cure, is on the horizon, the WHO warned today — as scientists reported the discovery of superbugs resistant to almost all known antibiotics in water supplies in New Delhi, India.

"In the absence of urgent corrective and protective actions, the world is heading towards a post-antibiotic era, in which many common infections will ... once again, kill unabated," Margaret Chan, director-general of the WHO, said today, in an address to mark World Health Day, which this year is devoted to combating drug resistance.

"We are at a critical point where antibiotic resistance is reaching unprecedented levels and new antibiotics are not going to arrive quickly enough," said Zsuzsanna Jakab, the WHO's regional director for Europe.

"Until all countries tackle this, no country alone can be safe."

Last year, at least 440,000 new cases of multidrug-resistant tuberculosis were detected, and the more serious, extensively drug-resistant tuberculosis has been reported in 69 countries to date, said the WHO.

Meanwhile, the malaria parasite is acquiring resistance to even the latest generation of medicines and resistance is also emerging to antiretroviral medicines for people with HIV/AIDS.  

There are few antibiotics under development — only two new classes of antibiotic have been discovered in the last three decades compared with 11 in the 50 years before that.  

The empty pipeline is partly the result of drug companies' reluctance to spend millions developing a new antibiotic, only to be told by regulators to restrict its use in order to manage the spread of resistance. 

"[Antibiotic] discovery needs to be underpinned by new financial mechanisms that allow companies to receive a return on their investment in new drugs, while limiting their use to situations of greatest need," David Brennan, chief executive of AstraZeneca, told a World Health Day event.

"If leaders in government, science, economics, public policy, intellectual property and philanthropy can come together, we will maximise the opportunities to develop and implement the creative solutions that will truly make a difference to tackling anti-microbial resistance," he said, according to the Dow Jones Newswires.

The dangers of rising drug resistance are underscored by the discovery, published today in The Lancet Infectious Diseases, that a gene that confers resistance to almost all known antibiotics is present in Indian water supplies.

Scientists from Cardiff University in the United Kingdom tested water samples within a 12-kilometre radius of New Delhi. They found the gene, known as New Delhi metallo-beta-lactamase (NDM-1), in a variety of bugs in two of 50 tap water samples and 50 of 171 community waste seepage samples, such as pools in streets.

Most worryingly, the study found the gene in cholera (Vibrio cholera) and dysentery (Shigella boydii).

The scientists said the discovery "has important implications for people living in the city who are reliant on public water and sanitation facilities".

They added that "international surveillance of resistance, incorporating environmental sampling as well as examination of clinical isolates, needs to be established as a priority".

Mohd Shahid, a researcher at the Jawaharlal Nehru Medical College and Hospital, Uttar Pradesh, India, wrote in an accompanying commentary: "Coordinated, concrete, and collective efforts are needed, initially, to limit ... widespread dissemination, and finally to combat this emerging threatening resistance problem".

The WHO today published a policy package that sets out the measures governments and their national partners need to take to combat drug resistance. It says they should develop and implement national plans; strengthen surveillance and laboratory capacity; ensure uninterrupted access to essential medicines of assured quality; regulate and promote rational use of medicines; enhance infection prevention and control; and foster innovation and research and development for new tools against drug resistance.

Link to full paper in The Lancet Infectious Diseases*

Link to full commentary in The Lancet Infectious Diseases*

Link to WHO policy package

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