Overcoming Antimicrobial Resistance – A European Report Recommends Deja-Vu Action

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Sometimes one comes across a particularly well-written policy document which summarizes the status quo of antimicrobial resistance by connecting and synthesizing data from all kinds of sources into a coherent framework.

The 2015 OECD Report on Antimicrobial Resistance in G7 Countries and Beyond: Economic Issues, Policies and Options for Action is such a document as it describes, analyzes the resistance trends and the bundles of measures already taken: a highly informative document…really well written.

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It provides a snapshot of the current situation, discusses the burden of illness, the complications caused by MDR infections, impact on mortality and cost to health care systems, trajectory of resistance trends for key pathogens as well as current national and more recent international efforts to stem the tide. It also presents a detailed and very useful overview of regulatory actions already in place.

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Source: OECP: Report on Antimicrobial Resistance in G7 Countries and Beyond. 2015

As one reads this compilation of facts and figures, one would expect some very specific recommendations for further corrective action. After all, the documentation shows that the combined actions already taken have proven inadequate; there is still a galloping cavalry of resistant organisms out there, which at best has been slowed down a bit. In most countries the trend to ever increasing resistance rates continues unabated.

Unfortunately, this is not the case. In the end, we are presented with a well-worn litany of policy suggestions that nobody would contradict but which, nonetheless, cannot be expected to make a significant difference. The recommendations for Health Policy makers are simply too vague and don’t break new ground.

More importantly, the document does not convey any sense of urgency. As we read about huge costs, increased mortality, rapidly spreading pathogens and a dry antibiotic pipeline, it seems as though the authors have not yet grasped the monumental general health care changes that come about once we lose the only major curative drug category ever discovered.

Without effective antibiotics to deal with the complications otherwise seen with advanced general and specialized surgical procedures such as organ transplantation, obstetrical and neonatal medicine, these and other medical practices will be affected and indications will have to change.

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Antibiotic Consumption [dose] per 1000 inhabitants per day (from: OECD Report: Overcoming Antimicrobial Resistance, 2015)
It will be painful; the push-back by special interest groups will be formidable. As an example, the US branch of government, the FDA, doesn’t even have the power to outlaw the use of antibiotics in veterinary medicine, an area where 80% of antibiotics are currently used, and which is a broiler unit in its own right, generating antibiotic resistance on a big scale. The OECD forecasts a further 67% increase in antibiotic consumption in veterinary medicine in the coming years.

The prophylactic use of antibiotics in veterinary and human medicine is a luxury which we cannot afford if we are serious about antibiotic stewardship and want to preserve a precious resource for the treatment of infections.  It is a practice to be stopped as well; it amounts to watering one’s lawn during a California drought!

It took an obstreperous personality like Ignaz Semmelweis to push through necessary reforms to change medical practice attitudes in 1850, and the same bulldog mentality is needed now.

   If every country had similarly high resistance rates, there would no longer be a correlation with per-capita antibiotic consumption. The nay-sayers would then argue that a linkage cannot be proven. We may be moving in that direction.  

Surgical and transplant operations are still performed, as if we still had the miracle drugs to bail us out. It is time to inform patients that the infection statistics for these procedures are no longer applicable, as we are much less able to handle infectious complications now than ever before. The increased mortality due to MDR pathogens needs to be publicly acknowledged before each operative procedure to the patient and the family and factored into decision-making of doctors and patients together. Insurers will also need to adjust premiums to reflect the increased risks of hard-to-treat or untreatable hospital acquired infections.

Somehow it seems that neither IDSA nor AMA have been as vocal and politically active as the situation would demand. The lawyer guild will most likely jump into the fray and ‘help’ us all make adjustments to the new reality, as we are entering the Brave New Post-Antibiotic World.

Antibiotic stewardship can make a difference – the Netherlands and Scandinavian countries have proven that MRSA can be controlled, bucking the trend to ever-greater resistance. However, their approach is neither easy to implement nor cheap. But it has proven to be cost-effective.

In contrast, the rich USA and cash-strapped Greece as examples share the same spost on the chart when it comes to resistance rates and antibiotic consumption (see Figure below). Not something to be proud of.

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The Correlation between Antimicrobial Consumption and PRSP Resistance (from: OECD Report: Antimicrobial Resistance in G7 Countries and Beyond. 2015)

Abbreviations:
PRSP    penicillin-resistant S. pneumoniae
OECD   Organisation for Economic Co-operation and Development

Reference:
M Cecchini. Antimicrobial Resistance in G7 Countries and Beyond: Economic Issues, Policies and Options for Action. 2015

 

 

 

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