Who antibiotic resistance graphic

Full infographic available from the World Health Organization.

The explosion of the global counterfeit drug trade has magnified antimicrobial resistance for ailments such as malaria, tuberculosis, HIV, diarrhea, and pneumonia.  Now public health experts in the United Kingdom are calling for an organization bring together global expertise to fight the threat of drug resistance.

The World Health Organization published a global report on antimicrobial resistance in April 2014, warning that a “post-antibiotic era – in which common infections and minor injuries can kill…is a very real possibility for the 21st Century.” The report states that bacteria resistant to common antibiotics have reached alarming levels in many parts of the world.  Following that report, Mark Woolhouse, professor of infectious disease epidemiology in the Centre for Immunity, Infection & Evolution at the University of Edinburgh and Jeremy Farrar, director of the Wellcome Trust,  detailed some examples of treatment resistant disease developing, in an opinion piece in the magazine Nature:

“Drugs that were once lifesavers are now worthless. Chloramphenicol, once a physician’s first choice against typhoid, is no longer effective in many parts of the world. Strains of extensively drug-resistant tuberculosis (TB), methicillin-resistant Staphylococcus aureus (MRSA), multidrug-resistant Escherichia coli and Klebsiellapneumoniae are serious threats to public health. Plasmodium falciparum (the parasite that causes the most dangerous form of malaria) is developing resistance to all known classes of anti­malarial drug, threatening the remarkable progress that has been made against the disease. HIV is increasingly resistant to first-line antiviral drugs. Every class of antibiotic is increasingly compromised by resistance, as are many antivirals, antiparasitic and antifungal drugs.”

As reported in SciDevNet, global disease experts want to see an international organization similar to the one set up to monitor antimicrobial resistance and develop global solutions, and “act to reduce the availability of counterfeit antibiotics” as well as the sale of over-the-counter antibiotics without mandatory prescriptions.

Variable doses of antimalarials in misbranded or counterfeit treatments expose malaria plasmodium to low levels of artemisinin, adapting them to drug tolerance. The Guardian reports, “The mosquito-borne illness is becoming resistant to the last anti-malaria drug standing – artemisinin – largely because of counterfeit medicines and incorrect usage.”  World Health Organization malaria and tropical parasitic disease expert, Prof. Pierre Ambrose-Thomas laments the tragedy of fake antimalarial treatments, “These fake medicines increase the risk of artemisinin resistance developed by the use of sub therapeutic dosages of antimalarials.”

Over-the-counter TB treatments provide low level antibiotic exposure to the bacteria that causes TB, allowing it to become acclimated to the antibiotic’s presence. CNN reports that in 2012 450,000 people worldwide were infected with a multi-drug resistant form of Tuberculosis.

Even Truvada, a drug that holds promise to keep HIV at bay, as reported by the New York Times, has already been found in counterfeit form in the United Kingdom.

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By S. Imber