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SF | INFECTIOUS DISEASES
March 2021 | Vol. 21 No. 3 www.medicalacademic.co.za
This article was independently sourced by Specialist Forum.
The post-antibiotic apocalypse is coming, warns WHO
By isolating, naming, and concentrating the antibacterial substance secreted by a penicillium mould, Dr Alexander Fleming discovered the first modern antibiotic in 1928. Subsequently, numerous antibiotics have been developed that are used to cure infections caused by bacteria.
S
ome 17 years after his discovery, he warned that “microbes are educated to resist penicillin and a host of penicillin-fast organisms is bred out…. In such cases the thoughtless person playing with penicillin is morally responsible for the death of the man who finally succumbs to infection with the penicillin-resistant organism. I hope this evil can be averted”. Unfortunately, Dr Fleming’s words proved to be prophetic. The World Health Organization (WHO) warns that antibiotic resistance (ABR) is rising to dangerously high levels in all parts of the world. New resistance mechanisms are emerging and spreading globally, threatening our ability
to treat common infectious diseases, states the WHO. A growing list of infections – such as pneumonia, tuberculosis, blood poisoning, gonorrhoea, and foodborne diseases – are becoming harder, and sometimes impossible, to treat as antibiotics become less effective. Without urgent action, we are heading for a post-antibiotic era, in which common infections and minor injuries can once again kill, warns the WHO.
Key drivers of antibiotic resistance It is estimated that 700 000 people die annually as a result of ABR, and this figure is set to rise to 10 million by 2050 if no action is taken, according to Farley et al.
An analysis of global antibiotic consumption from 2000–2015 showed a 65% increase in antibiotic use, largely in low- and middleincome countries including South Africa. More than 80% of antibiotics are used in the primary care setting. Suboptimal use of antibiotics is a key driver of ABR. ARB is evident in a patient for one month following an antibiotic course and can last for up to 12 months. It is therefore crucial to prescribe the fewest number of antibiotic courses for the shortest possible period of time. A South African retrospective medical record review by Gasson et al (2018) showed that only 45% of antibiotic prescriptions (654) adhered to guideline recommendations. Studies show
