Via The Lancet Infectious Diseases, an important editorial: Antimicrobial resistance: the Hydra among us. Excerpt:
With increasing antimicrobial resistance, there is concern that we might enter an era where we lose the essential contribution of antibiotics in treating bacterial diseases. Thus, to increase awareness of global antibiotic resistance and to encourage best practices among the general public, health workers, and policy makers, WHO has declared World Antibiotic Awareness Week for Nov 16–22, 2015.
This initiative follows the endorsement of the Global Action Plan on Antimicrobial Resistance by the World Health Assembly in May, 2015, which calls on all member countries to adopt appropriate strategies within 2 years. The Lancet will publish a series on antimicrobial access and resistance to coincide with the Awareness Week.
There is a fundamental challenge to any plan to adhere to the call of the World Health Assembly: most low-income and middle-income countries lack national surveillance systems for the prevalence of antimicrobial resistance. Implementation of antimicrobial stewardship plans at a national level is not possible if detailed information on the prevalence of antimicrobial resistance within the borders of a country is not available.
Some countries such as India are slowly developing a national surveillance system, but it will take years to gather comprehensive data to develop a global picture of antibiotic resistance that is essential to put in place appropriate measures.
But what should be the targets of strategies to fight antimicrobial resistance? The Centre for Disease Dynamics, Economics and Policy recently published The State of the World's Antibiotics, 2015, which highlights how the growth of antimicrobial resistance over the past years has been principally driven by the inappropriate use of antibiotics in two main areas: human use without medical prescription or in the presence of alternative measures, and widespread use as growth promoters in animal farming.
The indiscriminate use of antibiotics without specific medical control is a problem in countries where private citizens are able to purchase antibiotics over the counter without prescription. This situation can result in overuse of these drugs, use at suboptimal doses, and interruption of therapy courses if an early resolution of the symptoms occur, all situations that favour the emergence of antimicrobial resistance.
Equally problematic as a factor that can promote antibiotic resistance is the use of antimicrobial agents as a substitute for good hygiene standards; this is a particularly sensitive issue in hospitals where the combination of a high density of patients, easy circulation of pathogens, and suboptimal hygiene standards can be explosive for outbreaks of diseases caused by bacteria resistant to antimicrobial treatment.