Misuse, Overuse and Underuse

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Antibiotics Essentially Useless Against Many Diseases

W A S H I N G T O N, June 12, 2000

Misuse, overuse and underuse of certain antibiotics has rendered them almost useless against certain diseases, the World Health Organization said today.

We are literally in a race against time to bring down the levels of infectious diseases worldwide before the diseases wear the drugs down,” said David Heymann, WHO infectious diseases chief. Scientists have been urging action for years to fight the growing problem of infections becoming impervious to treatment. The WHO’s new report adds to the alarm.

This is a major problem for us, and it isn’t going to go away, added Dr. Jeffrey Koplan, director of the U.S. Centers for Disease Control and Prevention, who helped WHO unveil the report. We use the same antibiotics as other countries do, so resistance in one country is bad news for everybody. Overuse of certain antibiotics and failure of patients to take full dosages of prescriptions have rendered certain medications almost useless against some diseases and drug-resistant strains are becoming more prevalent, Heymann said.

Thirty years ago, penicillin was the first choice of treatment for either gonorrhea or staphylococcus infections, but today can no longer be used to treat those bacteria, according to the WHO report. Streptomycin also is no longer effective against tuberculosis.

Survival of the Fittest

Bacteria, parasites and viruses all naturally evolve to fight treatment. It’s classic survival of the fittest: Bugs exposed to drugs that don’t kill them become stronger, able to withstand subsequent treatment attempts, and pass on that drug resistance to their next generation.

Misuse of medications, particularly antibiotics, speeds this process.

In developed countries, people often overuse antibiotics, demanding them for viruses like colds. The body always harbors germs, so each unneeded antibiotic dose is an opportunity for them to evolve. U.S. and Canadian doctors are estimated to over-prescribe antibiotics by 50 percent, the WHO report said.

Underuse in Developing Countries

Impoverished developing countries have the opposite problem. Many patients can’t afford the full course needed to cure an infection. Antibiotics may be sold at market stalls where people buy a few doses without a doctor’s exam. In Vietnam in 1997, researchers found more than 70 percent of patients were prescribed inadequate doses to cure serious infections.

Then there’s misinformation: In the Philippines, people mistakenly use low doses of an anti-tuberculosis drug as a “lung vitamin”, WHO said.

Farm Use a Problem, Too

Animals add to the problem. Half the world’s antibiotics are used on the farm, sometimes to treat illness but mostly to help healthy animals grow bigger. That encourages drug-resistant germs that cause food poisoning, WHO said.

Nobody counts deaths from drug-resistant infections. The CDC says 88,000 Americans a year die of infections they catch in the hospital, and many are resistant to at least one antibiotic, complicating treatment attempts.

Wiser use of antimicrobial drugs is the solution, the WHO said. It recommended increased funding to help poor countries afford enough antibiotics, and education for poor and rich nations alike to avoid misuse.

WHO also recommended that human antibiotics not be used as growth promoters for animals. Europe already has banned several such drugs. The U.S. Food and Drug Administration has debated stricter rules here for several years, but is under industry pressure not to tighten animal drug restrictions.

The Associated Press contributed to this report.

WHO Report Statistics

Gonorrhea was once easily curable with penicillin and tetracycline. “Today, you can’t touch it anywhere in the world with those drugs,” Heymann said. Poor nations can’t afford more expensive alternatives and, to make matters worse, untreated gonorrhea is fueling spread of the AIDS virus.

In Estonia, Latvia, and parts of Russia and China, more than 10 percent of tuberculosis patients have strains resistant to two powerful medicines. Overall, up to 2 percent of the world’s 16 million TB sufferers have multi-drug resistant strains, particularly frightening because TB is airborne, spread when people cough.

Malaria, the mosquito-spread infection that kills a million people a year, is resistant to the top medication 80 percent of the time.

Some 5,000 Americans may have suffered longer-lasting food poisoning in 1998 from drug-resistant germs in chicken.
— Associated Press

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