A dramatic rise in global antibiotic consumption has led public health experts to call for fresh strategies to rein in excessive use of the drugs, and for major investments to provide clean water, sanitation and vaccines in countries where infectious diseases are rife.
The unrestrained use of antibiotics is the main driver for the rise in drug-resistant infections, which now kill more than 500,000 people per year worldwide, including 50,000 in Europe and the US combined.
Left unchecked, the spread of drug resistance could claim millions of lives per year by 2050, a 2014 report for then-British prime minister David Cameron showed.
Despite efforts to encourage more prudent use of antibiotics, an international team of researchers found a 65 percent rise in worldwide consumption of the drugs from 2000 to 2015.
The sharp upturn, revealed in sales figures from 76 countries, was driven almost entirely by rising use in poorer nations, the study found.
“We saw a dramatic increase in antibiotic use globally and this is mostly from gains in low and middle-income countries where economic growth means they have greater access to the drugs,” said Eili Klein, an author on the study at the Center for Disease Dynamics, Economics and Policy in Washington.
“While it’s generally a positive that there’s better access to effective antibiotics in these countries, there’s the potential for serious problems down the road from overuse. We know there’s a lot of inappropriate use in high-income countries, and many of these lower-income countries do not have the same controls in place,” Klein added.
Last month, Public Health England reported that at least one-fifth of antibiotics prescribed by general practitioners in England for coughs and sore throats were unnecessary.
A panel of experts convened by the agency found that while only 13 percent of people with a sore throat should receive antibiotics, 59 percent did when they visited their general practitioner.
The danger of drug-resistant infections is so serious that English Chief Medical Officer Dame Sally Davies has added antimicrobial resistance to the UK’s national risk register of civil emergencies.
Five years ago, she warned of an “apocalyptic scenario” where people die of common infections and simple operations, because antibiotics no longer work.
The latest study, published in Proceedings of the National Academy of Sciences of the United States of America, found that on average, poorer nations still use antibiotics far less intensely than richer ones.
In low and middle-income nations, the number of “defined daily doses” handed out per 1,000 people rose 77 percent from 7.6 to 13.5 over the 16 years studied.
However, richer nations consume antibiotics at nearly twice that rate.
Consumption in high-income countries fell on average by a modest 4 percent to 25.7 doses per 1,000 people.
Of particular concern is the steep rise in global use of antibiotics of last resort, such as colistin, a drug that has been reintroduced, despite being all but abandoned in the 1970s, because of its toxicity, the report said.
Colistin has been used for infections that cannot be treated with other drugs, but colistin-resistant bacteria have spread around the world after they emerged in a Chinese pig in the mid-2000s.
Klein and his coauthors criticized the global response to the public health crisis as “slow and inadequate”.
They called for a “radical rethinking” of policies to reduce antibiotic consumption, and advocated major investments to boost hygiene, sanitation and vaccinations in countries where antibiotic use is rocketing.
Without fresh interventions to curb overuse, the number of antibiotics handed out globally could rise more than 200 percent by 2030, from 42 billion doses per day in 2015 to 128 billion, the researchers said.
“The reality is that a lot of antibiotic overuse is for viral infections,” Klein said.
“Our modern medical system is built on effective antibiotics,” Klein added. “If our antibiotics stop working, if bacteria become resistant to most of them, medicine will be in trouble. The worry is that people don’t do anything about it.”
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