Cure With Care Understanding Antibiotic Resistance

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cure with careunderstanding antibiotic resistance



cure with careunderstanding antibiotic resistance

Action on Antibiotic Resistance

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contents

6introduction

references

antibiotic resistance-the challengean overview of thedilemmas facing the

world while trying towalk the fine line between legitimate useand needless abuse of antibiotics

what can be done?

identifyingthe pathwaysto making progress intackling

antibiotic resistance.

about ReActa new global effort to bringtogether allthose concernedabout antibioticresistance andits implicationsfor our world.

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Introduction

It is a catastrophe that our planet faces due tothe long-term impact of human activity onthe natural world.

The impact is already being felt in some waysbut the real damage still lies ahead of us, atthe most a few decades away.

And it is a problem that can be tackled if collective action is taken by all thoseconcerned to bring about significant policy and behavioural changes now.

Surely we are talking of global warming, the'hottest' theme on everyone's minds thesedays? No, in fact we are referring to anotherand equally significant threat that confronts

our world - that of antibiotic resistance - thephenomenon of pathogenic bacteriabecoming immune to antibiotic medication.

While global warming is all about the damage wrought by human intervention to macro-ecosystems antibiotic resistance is the story of

what we have done to micro-ecosystems- in

particular the universe of microbes, the oldestform of life on Earth. In the frightening way our planet seems to be developing resistanceto the presence and activities of human beingsliving on it similarly the invisible world of bacteria and viruses too have become resistantto our attempts to control and tame them.

In other words, while global warming

threatens to bring the skies crashing upon our

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heads antibiotic resistance, silent and faceless,is crumbling the ground beneath our feet.

Of course this is not a new problem sprung upon us suddenly by the vagaries of MotherNature.

The resistance of bacteria to antibiotics wasevident within just a few years of theintroduction of these miracle drugs over sixdecades ago and in the past thirty years this

has also been the focus of much concernamong medical professionals, public healthspecialists and even consumer groups.

Over the years of course there has been somesuccess in changing policies, ensuring bestpractices and changing behaviour of bothmedical practitioners and patients towards theabuse and misuse of antibiotics. Howeverdespite committed work by dozens of groups,

individuals and institutions the change has notbeen commensurate with the sheer scope of the threat involved.

There are several reasons for the apparentcomplacency among policy makers, in many parts of the world, when it comes to theproblem of antibiotic resistance.

In other words, while global warming threatens tobring the skies crashing upon our heads antibioticresistance, silent and faceless, is crumbling the ground

beneath our feet

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Information DeficitOne of the most obvious ones is plain lack of information and that is a gap that health

activist groups and concerned agencies needto address urgently. The collection of systematic data on the prevalence of antibioticresistance around the world is still in the early stages and ongoing efforts at filling up theevidence gap are yet to mature fully.

Compounding this situation is also the fact

that public funding for research on antibioticresistance has been low. In most industrialisedcountries the problem has been consideredan annoying but inevitable side effect of antibiotic use, and the epidemiological andsocietal aspects of antibiotic resistance havebeen neglected while the research agenda hasbeen decided by the pharmaceutical industry.

Communication GapSecondly, to describe the public healthconsequences of antibiotic resistance isdifficult and challenging because the problemof resistance involves diverse pathogens,transmitted in unique ways, which cause a

wide range of diseases.

The consequences for the patient, such as aprolonged disease or increased mortality,

which could be attributable to antibioticresistance, are hidden within a variety of clinical syndromes and the present difficultiesof measuring this resistance. Since antibioticresistance is not of itself a disease entity,invisibility characterises the issue, making itunknown and faceless for many people

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outside the medical field.

Complacency Factor

Thirdly, because of the previously continuousdevelopment of new antibacterial agents it hasbeen possible, in countries where new drugsare affordable, to change the therapy to new antibiotics when resistance levels to olderones have become 'uncomfortably' high. Thishas not been possible in poor countries wheremany of the second and third line therapies

for drug-resistant infections are unavailable,making the potential harm of resistance tofirst line antibiotics considerably greater.

The situation is now changing in industrialisedcountries, too. Because of the virtually empty pipeline of new drugs, clinicians are now facing a situation where the likelihood of success from empiric antibiotic treatment is

reduced and where patients are sometimesinfected with bacteria resistant to all availableantibiotics.

The Numbers Game Yet another reason for the low priority accorded by policy makers to antibioticresistance issues is that despite the steadily

increasing human toll extracted by untreatablebacteria, the numbers are still not as visible asfor other pressing public health problemssuch as AIDS, infectious diseases such asmalaria and tuberculosis or even the annualcarnage wrought by traffic accidents globally.However, the key point to note about theproblem of antibiotic resistance is that thepotential danger it poses to the world cannot

A difficult balance

The best

interests of the

individual

The globalneed for

sustainableantibiotic use

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be evaluated on purely quantitative groundsalone and one has to take a close look at thequality of threat involved.

Given how critical use of antibiotics is to anentire range of medical procedures fromcardiac surgery to organ transplantation theirloss of efficacy due to resistance is likely tocollapse some of most significantachievements of all modern medicine.

Without efforts to check and roll back theproblem of resistance our world could also goback to the pre-antibiotic era, where

thousands died routinely due to simplebacterial infections. All those in any positionof responsibility anywhere should do all they can to avert this dire possibility.

It is precisely for this reason that we at ReAct

-Action on Antibiotic Resistance - have cometogether to find ways of tackling the problemin all its dimensions in a holistic mannereschewing a purely bio-medical or technicalapproach.

We owe it to the future of our children topreserve the enormous medical benefitsantibiotics have brought to humankind.

Without efforts to check and roll back the problem of resistance our world could also go back to the pre-antibiotic era, where thousands died routinely due to

simple bacterial infections

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Antibiotic Resistance

- An Overview

A Clear And Present Danger A potential post-antibiotic era is threatening present and future medical advances. Thecurrent worldwide increase in resistantbacteria and, simultaneously, the downwardtrend in the development of new antibiotics

have serious implications.

Resistant bacteria dramatically reduce thepossibilities of treating infectious diseaseseffectively and multiply the risks of complications and a fatal outcome for patients

with infections of the blood.

Most vulnerable are those with weakenedimmune defences, such as cancer patients,malnourished children and people who areHIV-positive, for whom adequate therapy toprevent and treat severe infections is oftennecessary for their survival. In addition,antibiotic resistance jeopardizes advancedmedical procedures such as organtransplantations and implants of prostheses,

where antibiotics are crucial forpatient safety and to avoid complications.

Mortality as a result of infectious diseases1represents one-fifth of global deaths ;

respiratory infections are the leading killer,causing nearly four million deaths annually.

These deaths are to some extent regarded as

preventable with increased access to health

USA

Mexico

Brazil S. Africa

Japan

Taiwan

Korea

Singapore

France

Thailand

U.K

Argentina

Coombia

Worldwide spread of the 23F clone of penicillinresistant pneumococci

A Global Problem

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care and medicines. However, the globalemergence and spread of bacteria thatresist antibiotics is raising the question as to

whether this is still the case, especially in partsof the world where second and third lineantibiotics are unavailable.

The Global DimensionNo country today on its own can isolate itself from resistant bacteria. Antibiotic resistance isa growing international problem affecting

both current and future generations.Resistance that develops in one area of acountry may easily spread nationwide.

Globalisation, with increased migration, tradeand travel, has widened the range forinfectious diseases. A resistant strain of Streptococcus pneumoniae , first identified in Spain,

was soon afterwards found in Argentina,Brazil, Chile, Taiwan, Malaysia, the USA,Mexico, the Philippines, the Republic of

2Korea, South Africa and Uruguay .

Such examples underline the fact that nosingle country can protect itself from thethreat of resistant bacteria as pathogens arespreading across international, cultural and

ethnic boundaries. Although the effects of antibiotic resistance are more documented inindustrialised countries, there is a greaterpotential for harm in the developing world.

The HistoryIn the late 1940s, after less than a decade of penicillin being used to treat patients withinfectious diseases, unresponsive strains of the bacterium Staphylococcus aureus , the leading

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cause of hospital-acquired infections, were3detected in English hospitals . A striking

example of biological evolution had begun:bacterial strains with natural and acquiredresistance were being selected as a result of the use of antibiotics.

antibiotic-resistant bacteria and is withoutdoubt one of the best-studied pathogens.Since the 1980s the frequency of isolates of MRSA among Staphylococcus aureus hasincreased from close to zero to nearly 70 percent in Japan and the Republic of Korea, 30per cent in Belgium and around 40 per cent inthe United Kingdom and the United States.

It was discovered that mechanisms of resistance could be spread horizontally between different strains and differentbacteria and that, consequently, clones withmulti-resistant qualities could develop. Theproblem soon became serious for other

pathogens as well. Infections caused by multi-resistant bacterial strains such as Acinetobacter and Stenotrophomonas can in some cases nolonger be treated with modern antibioticsand the only available treatment is an oldantibiotic, colistin, earlier rejected for clinicalpurposes due to its toxic side effects.

Globally, escalating levels of the multiresistant

About a decade later the first report onresistance to the second generation of penicillin arrived; it came from a Bostonhospital, where Methicillin-Resistant strains of

Staphylococcus aureus (MRSA) had been4identified. MRSA has become a symbol of

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incentives, the level of training among healthstaff and pharmacists, and advertising toprescribers, consumers and providers from

the pharmaceutical industry.

In Europe, antibiotic consumption is fourtimes higher in France than in the

6Netherlands although the burden of diseaseis very similar in the two countries. Studiesfrom some developing countries show thatseveral antibiotics are generally prescribed at

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each consultation.

The relationship between antibiotic use andresistance is complex. Underuse, through lack of access to antibiotics, inadequate dosing and

poor adherence to therapy, may play as important a role in driving resistance as

8overuse. The use of broad-spectrumantibiotic agents as a substitute for precisediagnostics or to enhance the likelihood of therapeutic success increases the rate of selection of resistant bacteria.

In addition, counterfeit and substandard drugscontribute to sub-optimal concentrations of antibiotics, failing to control bacterialpopulations that are considered a risk factorfor developing resistance. It is estimated thatover 50 per cent of antibiotics worldwide ispurchased privately, from pharmacies or in theinformal sector from street vendors, without

In Europe, antibiotic consumption is four times higherin France than in the Netherlands although the burden

of disease is very similar in the two countries

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prescriptions. Half of the purchases are for

used in animal-rearing practices. In Europe

one-day treatments or less, an example9reflecting the magnitude of the problem.

Once resistant strains are selected, theirspread is promoted by factors such asovercrowding and poor hygiene together withhigh antibiotic use. One example is day carecenters, which provide ample opportunitiesfor the transmission of infectious diseasesand, in particular, the emergence of resistant

Streptococcus pneumoniae . The combination of the presence of young, susceptible childrensuffering from recurrent infections and theuse of multiple, often broad-spectrumantibiotics makes such environments ideal forthe carriage and transmission of thesebacteria.In the hospital setting, some bacterial cloneshave been more successful than others in

spreading extensively. One example of therapid dissemination of such epidemic clonesis the MRSA epidemic in England and Wales

where the frequency of MRSA among Staphylococcus aureus in blood culturesincreased from less than 5 per cent in 1994 to

10present levels of just below 50 per cent.

Antibiotics For Non-Human UseFollowing their success in medicines forhuman beings, antibiotics have beenincreasingly used to treat and prevent diseasesin animals, fish and plants. Besides this, sub-therapeutic doses of antibiotics have beenshown to have growth enhancing effects and have for decades been intensively

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and North America, antibiotic use in theanimal sector constitutes around half of the

11total consumption.

In 1987 more than 90 per cent of the drugsused on animals in the United States was

12administered without veterinary consultation. Within the European Union most antibioticsin feedstuff have been prohibited for anumber of years, but in many countries largenumbers of animals, irrespective of their

health status, are exposed daily to sub-therapeutic concentrations of antibiotics.Some growth promoters belong to groups of antibiotics, such as glycopeptides, that areessential drugs in human medicine for thetreatment of serious, potentially life-threatening infections. Emerging multiresistant bacteria from farm animals aretransmitted to humans mainly through the

food chain or by direct contact. The parallelemergence in animals of resistant strains,especially of Salmonella and Campylobacter , iscontinuously bringing in new clones thatcause infections in human beings.

Mortality, Costs And Ecology Through the selection pressure caused by

antibiotic use, a large pool of resistant geneshas been created. Today, we are starting to seethe tip of the iceberg. Slowly, the healthimpact is emerging.

Failure of the initial antibiotic regimen due toresistant bacteria increases the risks of secondary complications and a fatal outcome,underscoring the clinical dilemma of empirical

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therapy and the prevailing lack of rapiddiagnostic tests.

Recently, a study in intensive caredemonstrated significantly higher mortality among patients that received inadequateempirical therapy, compared with those given

14adequate therapy (42 vs. 17 per cent).Consequently, there is a clear justification forinitial broadspectrum therapy in severeinfections. This moves us into a vicious circle

where increasing levels of resistancenecessitate the use of broader, more potentantibiotics to secure patient survival but whereusing these reserve antibiotics escalates theproblem as resistance develops and creates asituation where effective antibiotics are

15lacking.

System Failure

Soon after the introduction of penicillin athorough inventory of biological compounds

with antibiotic activity was undertaken.

Substances with different target mechanismsto attack bacteria were developed into new categories of antibiotics by thepharmaceutical industry and were eagerly usedby medical professionals in their clinicalpractice. For many years, society's medicalneeds for antibacterial drugs were met by thepharmaceutical industry.

An apparent symbiosis between the interests

In 1987 more than 90 per cent of the drugs used onanimals in the United States was administered without

veterinary consultation

Number of death certificateswith MSSA/MRSA

13as underlying cause, UK

993 1995 1997 1999 2001 2003

500

1,000

1,500

2,000

2,500

Number of deaths

Not specified as resistant Resistant(MRSA)

0

2005

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of the community and those of theindustry prevailed. In the 1970s, innovativeresearch to develop new antibiotics gradually

waned, and the focus of research anddevelopment shifted to the fine-tuning of existing products. As resistance to antibioticsaccelerated, the fragile relationship betweenthe community and the pharmaceuticalindustry began to break down.

New antibiotics almost instantly faced the

problem of the evolution of bacterialresistance after being put on the market andthe short durability of antibacterial drugs wasgiving pharmaceutical companies cold feet.

The industry began increasingly to weigh up

its liabilities towards shareholders on the onehand and public trust and accountability to the community at large on the other.Difficulties arose as financial performanceconfronted the common good.

The cleft between public and private interestsgrew wider with the development of nationaland international drug policies aimed atcontaining resistance and restricting andrationalizing the use of antibiotics. Sharpeneddemands from regulatory bodies haveincreased the development cost of new medicines, and prioritising measures to secure

From a broad societal perspective, the industry mightbe expected to supply communities with good drugs

at affordable prices and provide reliable informationon them. Today, this is not the case.

Antibacterial needResistance

Antibacterialproductivity

Resistance/productivity/

Policies

Drug development and needs

?

Past Now Future

From A. White, in Antiobiotic Policies. Theory and practice, 2003

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optimal returns on investment have driven theindustry into other pharmaceutical areas withbigger and safer markets.

At present, the industry's ventures are shifting from therapy for acute conditions towardslong-term treatment of chronic diseases.Prospective investments in antibiotics aremore than ever competing with drugs formusculo-skeletal and neurological diseases

with 10 or 15 times greater 'net present value',

a measure used by the industry to predict thepotential success of products.

However, the need for antibiotics isanticipated to remain consistently high. Froma broad societal perspective, the industry might be expected to supply communities

with good drugs at affordable prices andprovide reliable information on them. Today,this is not the case.

It is clearly time for radical change.

Source: Data from Spellberg (2004)

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R&D Pipeline of 15 LargestPharmaceutical Companies



What Needs To Be Done? Although the full magnitude of theconsequences of antibiotic resistance for

society is still unclear, awaiting more databefore taking further action to contain theirspread is not an appealing option. Continuedcomplacency is unjustifiable and evenunethical in contexts where the lack of effective antibiotics is most imminent.

Rational Use of Drugs

An important reason for antibiotics losing their effectiveness is due to their widespreadirrational use through wrong selection ortaken in courses cut short by the expense of these drugs.

Thus, rational use of medicines is essential toresponding to this public health challenge.Health care providers, pharmacists,

consumers, and communities all over the world need to be supported to be moreindependent and knowledgeable aboutprescribing, recommending or matching medicines to people's needs.

Raising AwarenessSocial constraints and cultural views of

infectious conditions that requireantimicrobial treatment exert a strong influence on their use, particularly forcommunity-acquired pathogens.

Several countries have recently taken the boldstep of launching national campaigns toeducate physicians and patients aboutantimicrobial misuse and the threat of

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resistance. These campaigns show promise inchanging attitudes and behavior, among both

the public and healthcare professionals . If repeated regularly, the campaigns are likely toreduce inappropriate patient requests forantimicrobial agents, which in conjunction

with physician education models may reduceinappropriate antimicrobial prescriptionpractices

Better Diagnostics

Diagnostic uncertainty is a key driver of drug misuse and overuse, which can lead toantimicrobial selection pressure and increasedrates of resistant microbes . Therisks associated with untreated microbialinfection and the lack of accurate clinical or

laboratory prediction methods result in a low threshold for initiating empirical antimicrobialdrug therapy, especially if infection could belife threatening.

The availability of rapid diagnostics wouldhelp rational use and prolong the lifespan of available drugs.

New DrugsOnly two new classes of antibiotics have beenbrought to the market in the past 30 years. Itis already clear that new treatments are neededfor hospital-acquired Gram-negative bacterial

infections, for community-acquired resistant

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Continued complacency is unjustifiable and even

unethical in contexts where the lack of effectiveantibiotics is most imminent



infections, and for infections common indeveloping countries such as tuberculosis and

typhoid fever.

Vaccinology The development of new vaccines is likely tocontribute to the decreased transmissionand impact of antimicrobial-resistant bacteria.More so than antimicrobial agents, vaccineshave the potential to durably controlinfectious agents by blocking their ability to

disseminate within a population.

Fresh Investment in R&D To attract the industry sufficiently to return toinvesting in new antibiotics may require

concrete measures, including reducing thecosts of research and development as well assecuring the longer use of products.

These ideas are not new. In the area of neglected diseases an 'orphan drug system' has

developed to stimulate production of necessary drugs. Extended patents have alsobeen discussed as a way of directing industry investments. Increasing the returns oninvestment is the obvious key factor inpromoting drug development within theexisting framework; but can alternativeoptions be found outside the existing structures? Using a public health approach to

fill preventive and curative gaps in respect of

The availability of rapid diagnostics would helprational use and prolong the lifespan of available

drugs

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diseases where the industry has lost interest would be an attractive path to explore.

The prevailing perplexity of governments inthe face of the need to balance commercialand community interests in this issue must beresolved. At present, public and privateinterests are at odds society's continuously high needs contrasting with the diminishedaccountability of the pharmaceutical industry.Incentives for the development of new antibacterial drugs with novel mechanisms of action are essential.

Healthcare Regulation Antimicrobial use is affected by reimbursement policies, financial incentives,and healthcare regulation. There are severalexamples of how regulation can positively influence rational use of antibiotics.

Since 1999, the Chilean Ministry of Healthhas strictly enforced existing laws, whichrestricted purchase of antimicrobial agents

without a medical prescription. Theseregulatory measures had a sustained impact onantimicrobial use in the outpatient setting:sales of orally used antimicrobial agents

decreased by 43% from US $45.8 16million in 1998 to US $26.1 million in 2002.

Again, in 2000, against the strong oppositionof physicians and the pharmaceutical industry,a new Korean government policy prohibitedphysicians from dispensing drugs andpharmacists from prescribing drugs. This new policy decreased overall prescribing of

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antimicrobial agents and selectively reducedinappropriate prescribing of them for patients

17 with viral infections.

Global Action NeededInternational collective action is essential, yetresponsibility for health remainspredominantly national. Consequently, there isa potentially significant disparity between the problems and potential solutionsassociated with antibiotic resistance and the

institutions and mechanisms available to deal with them. Comprehensive recommendationson rationalising antibiotic use, from the WorldHealth Organization, the European Unionand other multilateral organisations, get lost

when it comes to translating them into actionplans in individual countries.

The difficulties of enforcing these

recommendations on a global level areevident. Presently, the links between the well-formulated strategies at the level of globalsociety and their acceptance by national policy makers are weak.

To identify these barriers so as to prevent themessage from repeatedly being returned to

sender is a major challenge, but one that needsto be overcome urgently.

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Vision, Mission, Values And Strategies

ReAct, Action on Antibiotic Resistance, is aninternational coalition of individuals,organisations and networks committed to

combating antibiotic resistance as a globalthreat to health.

VisionCurrent and future generations will haveaccess to effective prevention and treatmentof bacterial infections as part of their right tohealth.

MissionReAct seeks profound change in theunderstanding of, and responses to, infectionand antibiotic resistance through a socialmovement that engages civil society,community and consumer organisations,health policy reformers and those individuals,networks and institutions that generate and

analyse health-related knowledge. ReAct willcatalyse and co-ordinate action in ways mostlikely to make these changes.

In striving for its vision, ReAct is committedto change four fundamental dynamicsunderlying the ability to prevent and treatinfection. ReAct believes:

that antibiotics should be used

appropriately in humans, animal and

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Action on Antibiotic Resistance



plants their use reduced when of nobenefit, and their correct and specific useincreased when needed;

that hospital and community infectiousdiseases should be prevented throughimproved infection control and betterhygiene and nutrition;

that awareness is needed of the ecologicalbalance in all aspects of human life aspart of a comprehensive and integral

concept of health;that the root causes of antibioticresistance, as well as effective responses,are social, political and ecological as muchas scientific and technical.

ValuesReAct

strives to base its arguments on thehighest quality of science;

maintains due respect for traditional andindigenous medical systems that may have the potential to help preventantibiotic resistance;

stands against the use of microbes asagents of bioterrorism and strongly

opposes efforts to develop antibioticresistant strains towards such ends;

works towards equitable health care accessfor all people in its advocacy forprevention and treatment of infectiousdiseases;

recognises the unequal burden of antibiotic resistance on the poor and

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disadvantaged, especially women andchildren, and supports their advocacy forhealth;

respects the right of people in allcountries to informed consent, ethicalstandards for clinical trials, and highstandards of research conduct, andrequires partners joining its work torespect this principle;

functions in a transparent manner so as

to detect and avoid any conflict of interest perceived or real in its ownactivities to ensure the credibility of itspolicy voice.

StrategiesReAct will mobilise attention to, resourcesfor and collaboration to combatdevelopment and spread of antibiotic

resistance around the world by:

stimulating, organising and supporting political, professional and community action;

making the burden of antibioticresistance more transparent to policy makers and the public, and advocating

that governments set up effective systemsto reduce it;

encouraging and supporting processes of consumer and health care workerempowerment;

building alliances with groups across various sectors, and linking to campaigns with related and shared goals, such as

those dealing at global and country level

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with HIV and AIDS, tuberculosis, malaria,patient safety and the rational use of medicines;

promoting strategies for the developmentof new antibacterials and complementary technologies, including diagnostics and

vaccines, that might reduce reliance onantibiotics;

promoting new ways of approaching theproblem of antibiotic resistance including

a new understanding of the fundamentalrelationships, both beneficial and harmful,between humans, microbes, other living beings, infection, medicines and lifestyle.

Contact: [email protected] www.reactgroup.org, phone +46 (0) 18-471 6607

Visiting address: Drottninggatan 4, Uppsala.Sweden,

Postal address: Box 256, ReAct, UppsalaUniversity, SE- 751 05 Uppsala

Note: ReAct currently receives support, from the Swedish International Development

Cooperation Agency (Sida)

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References1 Geneva:World Health Organization, 2000.Available

from:www.who.int2

3Rubin MA, Samore MH.Antimicrobial Use and Resistance. .2002 Dec; 4(6): 491-497

Bronzwaer SL, Cars O, Buchholz U, Molstad S,GoettschW,Veldhuijzen IK, Kool JL, Sprenger MJ,Degener JE, European Antimicrobial Resistance SurveillanceSystem. A European study on the relationship between

antimicrobial use and antimicrobial resistance. 2002Mar;8(3):278-82.5Bhutta Z, 2006, Personal communication/manuscript inprocess .6Cars O, Mölstad S, Melander A. Variation in antibioticEuropean Union. Lancet 2001;357:1851-53.

7Radyowijati, A. and Haak, H, 'Determinants of Antimicrobialuse in the developing world', USAID, Bureau of GlobalHealth, The Child Health Research Project Special Report,2002.

10Health Protection Agency, UK. Staphylococcus aureusbacteraemia laboratory reports and methicillin susceptibility:England and Wales 1992-2002.

http://www.hps.org.uk/infections/topics_az/staphylo/lab_data_staphyl.htm. (Accessed 30 June 2004).11 WHO fact sheet on Antimicrobial resistance, 2002,

http://www.who.int/mediacentre/factsheets/fs194/en/print.html.(Accessed 30 June 2004).

12Stöhr K, Problems from antimicrobial use in farming.Essential Drug Monitor, 2000, Issue no. 28-29: 10-11.

13MRSA: Deaths continue to rise in 2005. Health StatQuarterly. Spring 2007 Available at:http://www.statistics.gov.uk/cci/nugget.asp?id=1067

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Kollef MH, Sherman G, Ward S, Fraser VJ. Inadequate

Zaidi AK, HuskinsWC,Thaver D, Bhutta ZA,Abbas Z,Goldmann DA.Hospital-acquired neonatal infections indeveloping countries. Lancet. 2005 Mar 26-Apr1;365(9465):1175-88.

4

8 WHO, Global strategy for containment of antimicrobial

resistance, 2001, WHO/CDC/CSR/DRS/2001.2, Geneva.9 WHO-EMRO, Agenda item 11(a): Antimicrobial resistanceand rational use of Antimicrobial agents, WHO website:

www.int/medicines/organization/par/cd_25th_anniversary/4- rational/amr.ppt. 49th Session of the Regional Committeefor the Eastern Mediterranean;30 September - 3 October 2002, Cairo, Egypt. (Accessed 30

June 2004).



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antimicrobial treatment of infections: a risk factor for hospitalmortality among

15Paterson D, Rice L B, Empirical antibiotic choice for the seriously ill

patients: Are minimization of selection resistant organisms andmaximization of individual outcome mutually exclusive? ClinicalInfectious Diseases, 2003; 36: 1006-12. critically ill patients. Chest,1999 Feb; 115(2): 462-74.

16Bavestrello L, Cabello A, Casanova D. Impact of regulatory measuresin the trends of community consumption of antibiotics in Chile. Rev Med Chil. 2002;130:126572.

17Park S, Soumerai SB, Adams AS, Finkelstein JA, Jang S, Ross- DegnanD. Decreased inappropriate antibiotic use following a Korean nationalpolicy to prohibit medication dispensing by physicians. Health Policy Plann. 2005



Among several alarming global publichealth problems with the potential torapidly reach disastrous levels, resistance toantibiotics seems to be one of the mostserious.

Antibiotics are the cornerstone of modernmedicine which have revolutionized medicalcare in the past half a century - from cradleto grave the role of antibiotics insafeguarding the overall health of humansocieties is pivotal.

In order to calculate the full economicburden of antibiotic resistance we have toconsider the burden of not having

antibiotics at all, which at the extreme willprobably collapse the entiremodern medicalsystem

.

In this booklet, Action on Antibiotic

Resistance(ReAct) exploressome of thereasons for rapid

spread of the problemand ways in which it can be

tackled. The booklet is aimed at policy makers and health officials everywhere butcould also be a useful introductory text on

the subject for all concerned.

Cure With Care Understanding Antibiotic Resistance

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