Antibiotic resistance posing little understood global health threat, WHO report says

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WHO AR ReportSurvey responses across 12 countries, six regions show range of awareness, common dangers, failures to communicate . . .

On the positive side, two-thirds of a sampling of people across the world are aware of antibiotic resistance and that it can affect them. On the more concerning side, three-quarters of those surveyed thought it was people, rather than bacteria, that become resistant to infection-fighting drugs. And fully a third believe that feeling better is a good reason to end a course of treatment without completing it.

These are some of the findings on global antibiotic use, knowledge, and awareness of resistance, detailed in a report the World Health Organization released today, as part of an inaugural campaign to highlight dangers in how drugs that laid the foundation for modern medicine are used today.

The Antibiotic Resistance: Multi-Country Public Awareness Survey report presents answers to 14 questions asked of more than 9,000 people in 12 countries in Africa, the Americas, Southeast Asia, Europe, the Eastern Mediterranean, and the Western Pacific. The countries, chosen, according to WHO, to represent a range of incomes in the regions were Nigeria, South Africa, Barbados, Mexico, India, Indonesia, the Russian Federation, Serbia, Egypt and Sudan.

The report presents misconceptions including on why and how antibiotic medicines should be used, with the majority of people (incorrectly) saying antibiotics should be used for colds and flu, while a minority — but still a quarter of those surveyed — said they thought it was okay to share antibiotics with a friend or family member.

Use, as well as knowledge of the dangers of antibiotic resistance varied widely, within regions. While with just 37 percent of those surveyed having heard of “antibiotic resistance,” Nigeria is home to the second lowest percentage of people knowing the term, South Africa is home to the greatest percentage of people who know sharing antibiotics with a friend or family member is not a good practice, and who know they should complete a course of antibiotic treatment (87 percent for both). Egypt is home to the smallest percentage of respondents who had heard of “antibiotic resistance.”

At the same time, the effects of bacteria that is now resistant to medicines designed to combat them are already dire, WHO Director General Margaret Chan emphasized during a telephone press conference launching the report, citing rising rates of drug-resistant gonorrhea, and an epidemic of multidrug-resistant typhoid “rolling across parts of Asia and Africa.”

The report notes that 57 percent of people agree with the statement “There is not much people like me can do to stop antibiotic resistance,” and concludes that is “concerning,” giving examples of some measures physicians and patients can take, including prescribing, and completing appropriate courses of treatment. It notes that people in many of the countries get medicines from street-sellers, but not whether they have other accessible sources of medicine. It makes no mention of tuberculosis, a disease requiring lengthy, toxic, expensive and income-interrupting treatment even when treatable with first line drugs, and for which the first new treatments in nearly half a century to address drug-resistance were recently developed but are not widely accessible. Chan, however, touched briefly on tuberculosis today saying: “Even with the best of care, only around 50 percent of multidrug-resistant tuberculosis can be cured.”

She also described “a post antibiotic era” when common and currently easily treated infections are not only deadly but challenge medical care across the board, including organ transplants, joint replacement, cancer chemotherapy and care for preterm babies. “This will mean the end of modern medicine as we know it,” Chan said.

This led a reporter to ask if the extremity of that rhetoric could sound like hyperbole and turn off the public.

No, said Dr. Keiji Fukuda of WHO,  “because it’s not theoretical. There are a lot of steps that can be taken. It can really be turned around.”

The steps he described, however optimistically, had an equally daunting ring, including, as they did, the development, not just now, but continuing even after their need is less clearly urgent, of new medicines, and distribution systems that ensure their appropriate use, “which all countries can do,” he added, without delving into the extent to which health resources and systems in countries currently confronting those issues would have to change, “not just the richest ones.”

And so the impact of both lack of antibiotic resistance awareness and efforts to increase awareness remain a question, with another reporter asking if modelling had established timing for the scenario Chan described.

No, but some more proactive countries in the Nordic region have shown the difference that action on the issue can make, Chan said, before adding, speaking for the organization that delayed recognition of Ebola as an international health crisis until months after it had been reported in three capital cities, that wider scale steps on antibiotic resistance were overdue.

“We feel action should have been taken sooner,” she said.

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