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A new international campaign intended to slow the global rise of drug resistance takes aim at the complacent attitude many people have adopted about the use of antibiotics.
"One big message is that antibiotics are not without risk," says Rosamund Williams, MD, who is coordinating activities for the new campaign, launched last month by the World Health Organization (WHO). "The other big message is that we must work harder at preventing infections in the first place."
The campaign highlights the rise of resistance not just to TB drugs, but to drugs across the entire spectrum, says Williams. In societies where drugs are misused, underused, or overused, high resistance rates tend to develop to many classes of drugs, not just one, she adds.
Overall, resistance to TB drugs accounts for only a small portion of all kinds of drug resistance. "If you stack TB drug resistance against, say, hospital-acquired infections, you find other resistant infections are far more common," she points out. In a society with lots of drug resistance, virtually every patient with gonorrhea might well have a drug-resistant strain, while drug-resistant TB might be confined to just 8% to 9% of the population in a certain region or area.
But that’s not really a meaningful comparison, Williams notes. "That’s because drug-resistant TB is a much longer-term problem, and one patient with drug-resistant TB can transmit infection to many others," she says.
On the plus side, drug-resistant TB has a built-in opportunity other resistant diseases usually lack, Williams says. With TB, there exists a formal structure — namely, the public health clinic — to allow patients to receive treatment and to allow the enactment of measures to decrease inappropriate drug use. "That’s not the case with many of the other, so-called trivial’ infections," she adds.
Strategies proposed by the new campaign target all segments of society, says Williams. Better-informed patients will cease to pressure physicians to give them antibiotics they don’t need. Better-informed physicians will prescribe only drugs that are needed. Hospital managers can implement procedures to monitor the effectiveness of drugs that are used. Health ministers can make sure the most critical drugs are available.
The initiative’s patient-specific recommendations include the following:
For prescribers and dispensers, specific recommendations include:
The new campaign also targets the use of drugs by the livestock and poultry industries to promote growth and treat sickness. The use of drugs as growth-promoters should be curtailed and gradually phased out, recommendations say. At present, half of all antibiotics produced are used in the livestock industry. Drug-resistant microbes in animals can infect humans as well.