Methicillin-Resistant Staphylococcus aureus (MRSA). Picture: NIAID, Flickr
Antibiotic resistant bacteria – this feared killer has for a long time been a catastrophe in the distant future. But it is increasingly clear that this is no longer only a warning for future generations, resistant bacteria are already here and the number of deaths because of them is growing by each passing day. While the situation is not yet as dire as it might become, the world is increasingly struggling to deal with these so called “superbugs”.
One of the places where the situation looks the grimmest is India. The country is currently grappling with a fast increase in antibiotic-resistant bacteria. Last year more than 58 000 babies died as a result of resistant infections. This is only a small part of the total number of infant deaths in the country, numbering around 800 000 yearly, but that share is likely to rise and resistant bacteria risk reversing the downward trend in child mortality. The reason India is a hotbed for “superbugs” is foremost due to the often alarming sanitary situation. Bacteria spread easily since half of the population defecate outdoors and sewage systems are substandard, the overcrowding does not help the situation either. In addition Indians use more antibiotics than any other country, and the use of antibiotics is largely uncontrolled.
Recently India has taken some steps to improve the situation. For example Prime Minister Narendra Modi has launched a campaign that aims at building toilets in order to reduce open defecation. They have also implemented stricter rules on the sales of antibiotics. But the news are not all good; hopes were high that Prime Minister Modi would increase the country’s health care spending, one of the lowest in the world at around 1 % of its Gross Domestic Product (GDP). But when the government’s new budget was released late last year it became clear that the health care budget would instead be slashed with nearly 20 %. Fiscal strains are quoted as being the reason for the cuts, which also includes a 30 % spending cut on the country’s HIV/AIDS program. Troubling news since India has the third largest number of people living with HIV.
Steps are taken in many countries to reduce antibiotic use, here a campaign in UK. picture: DES Daughter, Flickr
But it is not only India that overuses antibiotics; most countries are guilty of overuse. The amount used is however very different between countries; USA is the industrialised nation whose people uses the most antibiotics, at almost twice the amount of Germany and the Netherlands. Resistant bacteria are also reaping victims in the States; two million Americans are affected by resistant bacteria every year, and 23 000 people die because of it. The cost to the health care system is estimated at $21 to $34 billion dollars. In Europe it is estimated that 25 000 die annually. Thankfully there have been efforts to reduce the amounts of antibiotics used, often with great success. Prescriptions have been going down in Europe and USA; however at the same time those achievements are almost entirely offset by increasing use in the developing world. Globally the sales of antibiotics for human use grew with 36 % between 2000 and 2010. Five countries stood for the majority of that increase: Brazil, Russia, India, China and South Africa.
But what diseases are we talking about? Well, most bacterial infections could become troubling, to the point where babies risk dying of a simple strep infection. Diseases that were almost eradicated in the west are also starting to make a comeback. Tuberculosis is one of the diseases that could pose an enormous global health problem if resistant strands start spreading. The potential scale of the problem becomes clear when one considers that tuberculosis already kills roughly 1.5 million people a year. Drug-resistant TB exists all over the world but recently reports have made it clear that cases of multi-resistant tuberculosis are increasing fast, especially in former Soviet countries. Globally around 3.5 % of the cases are resistant to antibiotics but for example in Belarus that number is 35 %.
Unfortunately that is not the only depressing fact when it comes to antibiotic use. Antibiotics are not only used for human consumption, in fact it represents the smallest part in many countries. Agriculture poses a huge problem in both industrialized and developing countries, where large amounts of antibiotics are used in animal rearing. While India and other developing countries might have the largest problem concerning human use, it is the USA that carries the heaviest blame for agricultural use. It is estimated that 80% of all antibiotics in USA are used in the meat industry. Antibiotics are used to prevent and treat diseases in the animals, which are prevalent because of the conditions the animals are brought up in. However, even if diseases are common it has been estimated that over half of the prescriptions in the USA are unnecessary. A small silver lining however is that President Obama signed an executive order in September to combat the rise in resistant bacteria, and in the budget for 2016 he has pledged a major investment of 1.2 billion dollars, to the cause.
However, one cannot help but wonder; is it not too little, too late? Deaths from resistant bacteria are growing but the world is only taking small steps to counter the development. The situation is looking grim and it is likely that the world is no longer only standing on the ledge, looking down into a possible pre-antibiotic darkness. We might already have started to slip down this slippery slope.
Lotta Herz
