Issue 13 / 27 September 2010

WE NO longer have effective and safe antibiotics to treat certain infections. It’s a situation that the World Health Organization has described as a “growing and global public health problem”.

The health catastrophe we potentially face was made clear at a recent international conference that reviewed the inexorable increase and spread of antibiotic-resistant microorganisms, the continued worldwide inappropriate use of antibiotics and an R & D pipeline of new antimicrobials that has slowed to a trickle.

The conference, at Uppsala University, Sweden, was organised by ReAct, a global network of individuals and organisations committed to action on antibiotic resistance.

Presentations at the conference, attended by 190 delegates from 45 countries, drew a parallel between global warming and antibiotic resistance through the collective failure of the current market system, research prioritisation, public policy and global governance to overcome this major health problem.

The basic problem with profit-driven pharmaceutical R & D is that there is no prospect of the pharmaceutical industry getting a reasonable return on investment from antibiotics compared with drugs used for chronic disease.

The use of new antibiotics that are active against resistant microorganisms must be restricted to preserve their efficacy.

Yet to give the pharmaceutical industry a return on investment, the price of restricted antibiotics would be so high it would deny access to people in developing countries with a compelling need for them.

Conference participants — including pharmaceutical industry representatives — agreed it is time to end the link between industry investment for new antibiotics and market sales and replace it with relationships that encourage wider access to these drugs without exacerbating antibiotic resistance.

Innovative suggestions to share R & D resources, risks and rewards between the public and private sectors included improved access to proprietary compound libraries, open source innovation platforms and public–private partnerships.

Related tasks to maintain access to effective antibiotics are:

• Surveillance — monitoring antibiotic use and resistance patterns
• Infection control — curtailing the spread of resistant microorganisms and their genes
• Antibiotic stewardship — rational use, immunisation and better diagnostics
• Controlling non-medical antibiotic use in agriculture, aquaculture and veterinary practice.

Governments have been slow to recognise the implications of antibiotic resistance.

In 1998, Australian health and agriculture ministers established a Joint Expert Technical Advisory Committee on Antibiotic Resistance (JETACAR) that produced 22 recommendations, which were accepted, but after more than a decade only a few have been implemented.

But there is hope.

The Australian Commission on Safety and Quality in Health Care is working on some of the unimplemented recommendations, including antimicrobial stewardship to encourage appropriate use of antibiotics.

These and other strategies will be reviewed in February 2011 at a summit organised by the Australasian Society for Infectious Diseases and the Australian Society for Antimicrobials (ASID).

Dr Harvey attended the Uppsala conference with three other Australians. He was one of the inaugural authors of the Australian Therapeutic guidelines: antibiotic and a member of the federal government committee that devised the Quality Use of Medicines plank of Australia’s National Medicines Policy. He is currently an Adjunct Senior Lecturer in the School of Public Health at La Trobe University, Melbourne.

Posted 27 September 2010

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