England’s chief medical officer warns of ‘antibiotic apocalypse’.

England’s chief medical officer warns of ‘antibiotic apocalypse'. (Guardian).

The “antibiotic apocalypse” may already be upon us. According to Dame Sally Davies, chief medical officer for England, 50,000 people are dying every year in Europe and the US from infections that antibiotics have lost the power to treat. 

Davies has been at the forefront of the UK’s efforts against antimicrobial resistance (AMR) and taken on a global leadership role. She has described the threatened loss of antibiotics to the world as on a par with terrorism and climate change. 

As the final report of Jim O’Neill, the economist charged by the prime minister with finding solutions to the crisis, was published, Davies warned that the death toll was already high and our life spans, which once seemed to be forever lengthening, may fall. 

“We are already seeing the consequences of AMR, with estimates of around 50,000 deaths per year recently in Europe and the US, due to antibiotic resistant infections, and far greater numbers worldwide,” Davies wrote in the foreword to a report by the Institute and Faculty of Actuaries on antimicrobial resistance. 

“The projected figures are much more worrying. It is quite possible – and perhaps even likely – that the recent era of material mortality improvements will give way to many years of material mortality worsening.”

From tuberculosis to gonorrhoea, infections that used to be easily treated have once again become a serious threat. There are an estimated 480,000 cases a year of multi-drug resistant TB and 190,000 deaths from it. MDR-TB is hard to treat, requiring two years of antibiotics that are not available or affordable in some poorer countries. The World Health Organisation has just recommended a new shorter regime, lasting nine to 12 months, but cases of extremely drug resistant disease – XDR-TB – have emerged and are often lethal. 

Antibiotics are vital in the prevention of infection as well as its cure. Without them, surgery would again become life-threatening. Organ transplant patients rely on them because their own infection-fighting immune system must be suppressed by other drugs to prevent the body rejecting a donor organ. Childbirth could become much more dangerous. Pneumonia was known as “the old man’s friend” because it was so often the cause of death in the pre-antibiotic era and could be so again. 

The golden era of antibiotics, when new ones were often being discovered, is long past. It has become increasingly difficult for pharmaceutical companies to develop new ones as the old ones have lost their power to cure through over-use. Bacteria become drug-resistant by evolving to overcome antibiotics. That means new drugs must be used as little as possible, to keep them for extreme circumstances where the older drugs fail. 

So the old model, in which pharmaceutical companies develop a new drug and then market it to sell as much as possible, is not in anybody’s interest, because the more these drugs are used the faster they lose their potency.

Here is the report in PDF form from the Institute and Faculty of Actuaries:  Download Longevity%20Bulletin%20Issue%208%20FINAL%20FOR%20ONLINE. See also this May 18 comment in The Lancet on what it is likely to cost us by 2050 if we neglect the issue: US$100 trillion.

"Guess What" Deadly H7N9 virus develops drug-resistance to Tamiflu

"Guess What" Deadly H7N9 virus develops drug-resistance to Tamiflu. (YourHealth).

TAIPEI, Taiwan - The only H7N9 patient so far in Taiwan was carrying two strains of the same virus, with one being drug resistant and the other not, making it tricky to treat to him, doctors said.

Huang Li-min, a doctor from National Taiwan University Hospital (NTUH), explained that it was possible the avian flu virus was not drug resistant when the patient was first infected, but mutated later to become resistant to Tamiflu. 
With Tamiflu failing, NTUH later switched to another intravenous drug, Huang said. Because of the presence of the two strains simultaneously, it was difficult for doctors to determine how much the virus’ drug resistance had undermined the therapy Chou Chi-hao, deputy director-general of the Centers for Disease Control (CDC), said it is natural for viruses to mutate, saying the H1N1 flu strain mutated after infecting human beings.
But Huang said H7N9 has limited chances of human-to-human transmission through respiratory secretions because the virus has difficulty surviving the environments of human upper respiratory systems. Patients do not have symptoms of a runny nose or sneezing.
The patient, surnamed Lee, got sick on April 12, three days after returning from a business trip in China. His condition was initially critical, but has improved much. He has already been transferred from the intensive care unit to an ordinary ward at NTUH. The findings by the NTUH and CDC about H7N9 are to be published in a local medical journal next month. Resistance is of concern in the scenario of an influenza pandemic (Wong and Yuen 2005), and may be more likely to develop in avian influenza than seasonal influenza due to the potentially longer duration of infection by novel viruses.Read the full story here.

Young adults be Warned - CDC Says That There’s Only One Drug Left to Treat Gonorrhea.

Young adults be Warned - CDC Says That There’s Only One Drug Left to Treat Gonorrhea.(STD).Six months after a warning was published in the medical journal The New England Journal of Medicine that gonorrhea was quickly becoming untreatable by the last two effective drugs, the CDC reports that one of those drugs no longer works. That just leaves one antibiotic to treat the disease, which is caused by the bacterium Neisseria gonorrhoeae. The bulletin, which was published on August 9th, states that there is a high enough percentage of resistance to the oral antibiotic cephalosporin cefixime that the CDC no longer recommends using it as a first-line regimen for the treatment of gonococcal infections. Physicians should now use a single dose of injectable cetriaxone, accompanied by some additional oral drugs.The entire structure of the way that the USA controls sexually transmitted disease — single doses of drugs given in outpatient-clinic visits — is dependent on the effectiveness of the one remaining drug. Once cetriaxone becomes ineffective, gonorrhea will be treated by IV drugs, which is more expensive, complicated and slower.The fact that cetriaxone has to be used already complicates matters, because pills can be dispensed by any clinic worker whereas injections must be given by a licensed health professional. If the resistance gets works and the remaining drug becomes unusable, which could happen, over the next seven years, gonorrhea incidence would increase four-fold to nearly 6 million additional cases, nearly 800 additional HIV infections, a quarter million cases of pelvic inflammatory disease in women, and cost over three-quarters of a billion dollars.Read the full story here.