Views from the London School of Hygiene & Tropical Medicine

The drugs don’t work: the global threat of antimicrobial resistance

The Drugs Don't Work book jacketWe are facing an ‘apocalyptic’ threat from antibiotic-resistant superbugs, according to a new book by England’s Chief Medical Officer.

In The Drugs Don’t Work, published today, Professor Dame Sally Davies highlights how the misuse of antibiotics by patients and doctors has led to the emergence and spread of pathogen strains that cannot be controlled by currently available medicines. And unless we urgently research and develop new treatments, we risk soaring mortality from routine infections within a generation.

The World Health Organization estimates that antimicrobials add, on average, 20 years to our lives. For over seventy years, since the manufacture of penicillin in 1943, we have survived extraordinary operations and life-threatening infections. We are now so familiar with these wonder drugs that we take them for granted, writes Dame Sally.

She highlights that there are now examples of drug-resistant strains in all types of micro-organisms, including bacteria (eg Staphylococcus aureus), viruses (HIV and hepatitis B), fungi and parasites (malaria). No new class of antibacterial has been discovered since 1987, partly because companies can no longer make enough money out of antimicrobials to justify investing in the research needed.

Dame Sally sets out key strategies for tackling antimicrobial resistance, including improving hygiene practices to stop the spread of infectious diseases, tackling the overuse or false prescription of antimicrobial drugs and, importantly, increasing investment in antibiotic research.

“Our response needs to be global and multifaceted, but if we do work together, bringing the ingenuity of humanity to this real, growing and often forgotten global threat, we can manage and mitigate the risk of antimicrobial resistance, which is as important and deadly as climate change and international terrorism,” she writes.

Peter Piot, Director of the London School of Hygiene & Tropical Medicine, said: “The emergence of antibiotic resistant strains of common pathogens is a major threat to health and is already putting tremendous pressure on health services worldwide. As well as radically reducing the overuse and misdiagnosis of antibiotics, it is vital that we develop a new generation of treatments effective against the resistant ‘superbugs’.”

School researchers already work closely with the Department of Health, Public Health England, World Health Organization, Centers for Disease Control and other international agencies on tackling antimicrobial resistance. The search for new solutions is a key focus of the work of the Bloomsbury Research Institute, a developing partnership between University College London and the School, headed by Professor Simon Croft.

Investment in this area of research is a key priority. A recent study by a team of researchers including the School’s Joseph Fitchett, argued that although the emergence of antimicrobial resistance severely threatens our future ability to treat many infections, UK infection-research spend targeting this important area is still unacceptably small.

Earlier this year Richard Smith, Professor of Health System Economics and Dean of the Faculty of Public Health and Policy at the School, also called for further investment and warned that an increase in resistant organisms coupled with a big fall in the number of new antimicrobial drugs suggests an apocalyptic scenario may be looming.

Writing in the BMJ, Prof Smith and co-author Professor Joanna Coast from the University of Birmingham argue that it is difficult to forecast the likely economic burden of resistance. They believe even the highest current cost estimates “provide false reassurance” and this may mean that inadequate attention and resources are devoted to resolving the problem.

“Waiting for the burden to become substantial before taking action may mean waiting until it is too late. Rather than see expenditure on antimicrobial policies as a cost, we should think of it as an insurance policy against a catastrophe; albeit one which we hope will never happen,” they conclude.

Image: The Drugs Don’t Work book cover Credit: Penguin

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