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OpEdNews Op Eds    H4'ed 9/17/15

Antibiotic use is driving antibiotic resistance...

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Shobha Shukla, Citizen News Service - CNS

What will happen when drugs become ineffective? Preventable diseases KILL
What will happen when drugs become ineffective? Preventable diseases KILL
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... So suggests the new data released today by the Center for Disease Dynamics, Economics & Policy (CDDEP) via its ResistanceMap, an interactive online tool that allows users to track the latest global trends in drug resistance in 39 countries, and antibiotic use in 69 countries. CDDEP also issued the first-ever report on The State of the World's Antibiotics, 2015, that looks at the current state of global antibiotic use and documents alarming rates of bacteria resistant to last-resort antibiotics that can lead to life-threatening infections across the world.

Key Findings

Cause of antibiotic resistance: The greater the volume of antibiotics used, the greater the chances that antibiotic-resistant populations of bacteria will prevail in the contest for survival of the fittest. Two trends are contributing to a global scale-up in antibiotic consumption--(i) rising incomes are increasing access to antibiotics, which is saving lives but also increasing use-- both appropriate and inappropriate--which in turn is driving resistance; and (ii) increasing demand for animal protein and resulting intensification of food animal production is leading to greater use of antibiotics in agriculture, and hence increasing resistance.

Trends in antibiotic use: Both human and animal antibiotic use is rising dramatically in low and middle-income countries (LMIC)--particularly China, India, Brazil and South Africa. This increase, driven by increased prosperity, includes a great deal of unnecessary and irrational use and poses a major threat to public health. In many countries, like India, antibiotics can easily be purchased over the counter without prescription.

Human consumption: Between 2000 and 2010, total global antibiotic consumption grew by more than 30%--from approximately 50 billion to 70 billion standard units (SU), based on data from 71 countries. Even though per capita consumption is still higher in high-income countries, the greatest increase in antibiotic use between 2000 and 2010 was in LMICs, where use continues to rise.

The countries consuming the most antibiotics overall in 2010 were India, 13 billion SU; China, 10 billion SU; and the United States, 7 billion SU. However, in per capita terms among these countries, the United States led in 2010 with 22 SU per person, compared with 11 SU in India and 7 SU in China

In most countries, about 20% of antibiotics are used in hospitals/healthcare facilities, and 80% are used in the community, either prescribed by healthcare providers or purchased directly by consumers without prescription. Perhaps half of community use is inappropriate, for minor ailments that will not benefit from treatment, but add to the burden of antibiotic resistance. Hospitals generate some of the most dangerous and difficult-to-treat infections, a result of heavy use of antibiotics (especially in LMICs, where antibiotics may substitute for infection control).

In hospitals 7 times more antibiotics are used when they are given post- rather than pre-surgery. This not only increases costs but also contributes to the potential for antibiotic resistance. Even when antibiotics are administered before surgery, the regimen or duration of the therapy may be suboptimal: from 19 to 86% of patients in hospitals in India received inappropriate antibiotic prophylaxis

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