Report reveals urgency in fight against resistance

February 2005

A global report is sending an alert, urging action against the increasingly threatening presence of disease-causing microorganisms resistant to many of today’s front-line antibiotics.

The 2005 Global Advisory on Antibiotic Resistance Data (GAARD) report, “Shadow Epidemic: The Growing Menace of Drug Resistance,” provides findings from pharmaceutical companies, international scientists, clinicians and groups, such as the CDC and WHO, that continually track drug resistance worldwide.

Coordinated by the Alliance for the Prudent Use of Antibiotics (APUA), “Shadow Epidemic” offers a comprehensive view of global drug resistance issues.

The report indicates that drug resistance is a global pandemic, potentially threatening the treatment of every patient who contracts an infectious disease.

First recognized in bacteria, drug resistance is now becoming more apparent in other pathogens causing other infectious diseases, such as HIV/AIDS and malaria.

“Without coordinated action, we risk facing a return to the time when infectious disease deaths were commonplace and life expectancy was short,” said Stuart B. Levy, MD, APUA president, in a statement.

“In addition to the ominous findings, there is a larger problem of a complete lack of knowledge in vast regions of the world about the emergence of dangerous infectious agents,” Levy added. “Because microbes in one part of the world can easily spread to another, there is a national security mandate to expand our global surveillance networks throughout the world.”

Knowledge gap

The report highlights up-to-date information on resistance among respiratory infections, malaria, HIV/AIDS, gonorrhea, tuberculosis and staphylococcal infections.

Findings reveal a common thread of increasing treatment failures often attributable to antibiotic misuse and lack of knowledge about drug resistance. Among the report’s key findings:

• Potentially deadly staphylococcal infections contracted by healthy individuals in the community are on the rise. Skin infections caused by community-acquired methicillin-resistant Staphylococcus aureus have affected children, student athletes, military personnel, prisoners and select ethnic populations.
• Drug-resistant strains of HIV have emerged in affluent nations and are poised to strike developing regions where highly active antiretroviral therapies are just now becoming more accessible.
• The spread of malaria parasites resistant to chloroquine and other drug treatments has brought increased morbidity and mortality and raised the cost of treatment by 1,000%.
• Untreatable hospital infections are on the rise in industrial countries due to increased resistance among gram-negative bacteria, such as Klebsiella, Acinetobacter and Pseudomonas.
• Gonorrhea is increasingly impervious to traditional drug treatments, such as penicillin and tetracycline and, in some areas, quinolones. This has slowed the prospects for control and increased risk of HIV transmission.
• The cost of drug resistance for bacterial infections in the United States was last estimated in 1986 at $5 billion to $6 billion a year. There has been no official government study to update this estimate. Considering additional expenses now attributable to new drug resistance trends, the problem will become a large burden on health insurance and government health programs.

According to APUA, the drivers of the drug resistance problem include over-the-counter sales in developing countries, inappropriate patient demand and provider use in industrial countries and insufficient incentives for the development of the new drugs, diagnostics and vaccines.

Action now

Most needed, APUA believes, are immediate leadership and substantial investments from global governments. The report calls for a large, dedicated investment, worldwide, to keep track of and contain antimicrobial-resistant organisms and to continue to treat and cure infectious diseases.

Coordinated programs to improve the global knowledge of resistance; promote appropriate use of antimicrobials; and research and discover new drugs, diagnostics and infection control methods will pay off, the group said.

“Lack of adequate reconnaissance on drug resistance is a major barrier hindering our response,” said Thomas O’Brien, MD, vice president of APUA. “You can’t fight what you can’t see.”

The GAARD project was founded in 1998 as a public-private collaboration. GAARD coordinates the collection and analysis of data from worldwide surveillance systems for special studies to guide public health responses and antimicrobial resistance trends.

For more information:

• To view the full report, visit www.apua.org.