E-DRUG: WHO Plan To Halt Antibiotic Resistance

[srahmad@essential.org]

E-DRUG: WHO Plan To Halt Antibiotic Resistance
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WESTPORT (Reuters) -- The World Health Organization (WHO) has issued a 
three-part plan aimed at halting the spread of antibiotic resistant 
infections. 

Infectious disease experts have long warned that overuse and inappropriate 
use of antibiotics is causing bacteria to mutate into new strains that 
don't respond to treatment. The threat posed by such infections is global, 
according to WHO. 

In a commentary in the February 20th issue of Science, Rosamund J. 
Williams, a WHO infectious disease specialist, outlines the proposed 
course of action. "We propose a broad strategy: improve the rational use 
of antibiotics in human medicine, reduce the global selective pressure of 
antibiotics by reducing or eliminating uses other than in human medicine,
and reduce the spread of resistant organisms by improving hospital hygiene 
and public health infrastructure." 

"Rational use" is a difficult goal, Williams writes, because most 
prescribing of antibiotics is based on instinct or habit, rather than 
scientific fact. "Twelve million antibiotic prescriptions to adults in the 
United States in 1992 were for upper respiratory tract infections and 
bronchitis, on which these drugs have little or no effect." That level of 
overprescribing results, she writes, "-from patients' expectations and 
physicians' habits." 

The only way to break those habits is through education of both physicians 
and patients, according to the WHO expert. But currently most of this 
education comes from pharmaceutical companies, a source that may be 
biased. Williams said it would be better to develop unbiased curriculum, 
including "WHO's List of Model Essential Drugs and disease-specific
treatment guidelines." 

A key element in responsible prescribing is the use of laboratory tests to 
confirm the presence of bacteria. But often such tests require special 
equipment and additional time. WHO wants cooperation to develop new 
"-diagnostic tests that permit close-to-the-patient testing" so that 
pathogens can be correctly identified before prescriptions are written. 

Resistant infections are spread as easily as common infections and for 
that reason, WHO is urging renewed efforts to control infections 
originating in hospitals. In the US, treating these infections cost $4.5 
billion each year. According to WHO, reducing the rate of hospital-based 
infections by just 6% would be cost effective. 

Along with control programs, surveillance is needed. The program in 
Denmark, where antibiotic resistance is very low, best illustrates the 
utility of good surveillance. That country, "has introduced comprehensive 
monitoring of the consumption of antimicrobial drugs and the occurrence of 
resistant microbial strains in animals, food and humans." 

Finally, WHO is urging statutory regulation aimed at eliminating the 
profit motive from overprescribing. "No amount of education of technical 
advance will change prescribing patterns if individual or hospital income 
depends on profit from prescribing. In healthcare, other sources of income 
may need to be identified to compensate for the income loss because of 
reduced prescribing." SOURCE: Science (1998;279:1153-1154) 

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