Last year, a 30-year-old teacher suffering from a severe bloodstream infection arrived in my emergency room for treatment. The woman had been in and out of local clinics with a stubborn chest infection and fever, and by the time I examined her, she was receiving chemotherapy for blood cancer.
Instinctively, I treated her infection with an antibiotic from a group of drugs known as “carbapenems,” strong medicines commonly prescribed to people who are hospitalized, but after further tests, I discovered that she was carrying a strain of bacteria that is resistant to most antibiotics in our therapeutic arsenal. There was no option but to treat her with drugs that I knew would be largely ineffective; she was lucky to recover.
UNRESPONSIVE
Illustration: Yusha
Sadly, many patients are not so fortunate. Around the world, people are being admitted to hospitals with infections that do not respond to antibiotics, and relatively benign germs — like Klebsiella and Escherichia coli — have become potent killers, shrugging off medicines that in the past easily contained them.
Antibiotics are different from almost every other class of drug in one important and dangerous respect: The more they are used, the less effective they become. When microbes are repeatedly exposed to antibiotics, the bacteria eventually win.
Each year, an estimated 750,000 people die from antimicrobial-resistant (AMR) infections, and the death toll will climb unless the global health community acts decisively.
‘SUPERBUGS’
In the absence of detailed and reliable reporting from all countries, the British government commissioned a series of reports on AMR, estimating that by 2050, as many as 10 million people could die annually from AMR complications. Moreover, the economic impact of “superbug” outbreaks could top US$100 trillion; low-income countries would suffer disproportionately.
Uneven and unregulated antibiotic usage is one of the most important reasons behind the AMR crisis. In developed countries, doctors prescribe antibiotics for even the most basic maladies, like the common cold. Stronger regulations of antibiotics prescriptions in these countries, like those implemented in Finland several decades ago, could help to mitigate resistance.
Yet such rules alone will not be enough, because in much of the developing world, antibiotics can be obtained without a prescription. Inequalities in access to medicine, excessive use and poor sanitation services complicate the problem further. And when farmers use antibiotics to speed the growth of chickens and other livestock, drug-resistant germs find new ways to enter the environment.
GUIDANCE
In an effort to address these challenges, the WHO last year classified antibiotics into three groups and issued guidance for how each class of drugs should be used to treat 21 of the most common infections.
For example, the first of these groups consists of medicines that should always be available to patients, preferably by prescription. Amoxicillin, the preferred medicine for respiratory-tract infections in children, is in this group. The second tier includes carbapenems, which, as my patient last year discovered, are increasingly ineffective. And the third group, including colistin and other “last resort” antibiotics, are drugs that must be used sparingly and only for medical emergencies.
Clearly, guidelines are an important first step in addressing the global AMR challenge, but governments, medical associations and hospitals must also commit to tackling the antibiotic crisis together. That is what the healthcare community in India is doing.
STEWARDSHIP
In 2012, India’s medical societies adopted the Chennai Declaration, a set of national recommendations to promote antibiotic stewardship. Last year, Indian Prime Minister Narendra Modi used his monthly radio address to urge doctors to join the effort.
Still, the AMR threat remains real; containing it will require concerted effort. In India, for example, we must implement the regulation, formulated by the Indian Ministry of Health, controlling over-the-counter sales of antibiotics. The WHO’s advice should strengthen support for this move.
India’s “Red Line” campaign — which demands that prescription-only antibiotics be marked with a red line, to discourage the over-the-counter sale of antibiotics — is a step forward.
Meanwhile, healthcare communities in advanced economies must find the political will to reduce unnecessary antibiotic use by people and in agriculture. “Last resort” antibiotics should never be used as growth promoters in livestock farming, but achieving this will require significant changes to current practices.
Superbugs should strike fear in doctors and patients everywhere, but fear cannot lead to paralysis. The next time a patient arrives in my ward with a treatable infection, I need to be certain that the medicine I prescribe will be effective. Luck should never play a role in a patient’s recovery.
Abdul Ghafur, an infectious disease consultant based in Chennai, India, is the coordinator of the Chennai Declaration.
Copyright: Project Syndicate
Two sets of economic data released last week by the Directorate-General of Budget, Accounting and Statistics (DGBAS) have drawn mixed reactions from the public: One on the nation’s economic performance in the first quarter of the year and the other on Taiwan’s household wealth distribution in 2021. GDP growth for the first quarter was faster than expected, at 6.51 percent year-on-year, an acceleration from the previous quarter’s 4.93 percent and higher than the agency’s February estimate of 5.92 percent. It was also the highest growth since the second quarter of 2021, when the economy expanded 8.07 percent, DGBAS data showed. The growth
In the intricate ballet of geopolitics, names signify more than mere identification: They embody history, culture and sovereignty. The recent decision by China to refer to Arunachal Pradesh as “Tsang Nan” or South Tibet, and to rename Tibet as “Xizang,” is a strategic move that extends beyond cartography into the realm of diplomatic signaling. This op-ed explores the implications of these actions and India’s potential response. Names are potent symbols in international relations, encapsulating the essence of a nation’s stance on territorial disputes. China’s choice to rename regions within Indian territory is not merely a linguistic exercise, but a symbolic assertion
More than seven months into the armed conflict in Gaza, the International Court of Justice ordered Israel to take “immediate and effective measures” to protect Palestinians in Gaza from the risk of genocide following a case brought by South Africa regarding Israel’s breaches of the 1948 Genocide Convention. The international community, including Amnesty International, called for an immediate ceasefire by all parties to prevent further loss of civilian lives and to ensure access to life-saving aid. Several protests have been organized around the world, including at the University of California Los Angeles (UCLA) and many other universities in the US.
Every day since Oct. 7 last year, the world has watched an unprecedented wave of violence rain down on Israel and the occupied Palestinian Territories — more than 200 days of constant suffering and death in Gaza with just a seven-day pause. Many of us in the American expatriate community in Taiwan have been watching this tragedy unfold in horror. We know we are implicated with every US-made “dumb” bomb dropped on a civilian target and by the diplomatic cover our government gives to the Israeli government, which has only gotten more extreme with such impunity. Meantime, multicultural coalitions of US