World Health Day Marked with Warnings on Loss of “Wonder Drugs”

In 1928, Scottish bacteriologist Alexander Fleming discovered penicillin, considered a medical breakthrough of the century. Now some bacteria are resistant to the drug.

Medical science made a giant leap forward in the mid-20th century with the discovery of antibiotics, but now the prospect of a reversal in progress looms, as medications once known as “wonder drugs” lose their effectiveness.

Widely used antibiotics are losing their effectiveness against fighting disease because the bacteria they target have mutated to develop resistance to the medications. The syndrome is called anti-microbial resistance (AR), and it is “a growing problem with implications for both national and global security,” according to Dr. Rajiv Shah, the administrator of the U.S. Agency for International Development (USAID). “Drug resistance also threatens to reverse global health gains by making currently available first-line medicines less effective.”

Shah issued the statement in recognition of the World Health Organization’s (WHO) designation of April 7 as World Health Day, which this year focuses on the AR issue. Antibiotics have cured diseases that once were fatal, such as tuberculosis, pneumonia, gonorrhea or a simple wound infection. But when those first-line medications meet up with bacteria that have become resistant to them, Shah says, “the patient may have to be treated with second or third-choice drugs that are potentially less effective, more toxic and more expensive.”

WHO Director-General Dr. Margaret Chan said AR could also reverse an improving trend in the developing world of increased life expectancy. “Gains in reducing child deaths due to diarrhea and respiratory infections are at risk.”

Shah said USAID is supporting a WHO strategy for containing AR. “We pledge to contain the emergence and spread of antimicrobial resistance through the continued development of innovative tools and approaches that improve medicine use, assure medicine quality and strengthen health systems.”

WHO documents outline a six-point strategy to combat drug resistance:

• Develop and implement a comprehensive, financed national plan.

• Strengthen surveillance and laboratory capacity.

• Ensure uninterrupted access to essential medicines of assured quality.

• Regulate and promote rational use of medicines.

• Enhance infection prevention and control.

• Foster innovation and research and development for new tools.

Bacteria will develop drug resistance as a natural course of evolution, but medical experts say that human use of antibiotics has sped the emergence of AR. Too frequently, antibiotics are prescribed to treat viruses, which they won’t cure, rather than bacterial diseases. Sometimes a much longer course of antibiotics is prescribed or, Chan says, too few are consumed by the patient.

“This includes underuse, especially when economic hardship encourages patients to stop treatment as soon as they feel better, rather than complete the treatment course needed to fully kill the pathogen,” according to Chan’s statement.

This tendency is a key reason for the emergence of multidrug resistance tuberculosis. The full course of treatment for TB calls for about six months of drug therapy, even though a patient will feel better within a much shorter time. Feeling healthier, patients fall off the medication regimen because of cost or uncomfortable side effects.

Given that there are many reasons an antibiotic can become ineffective, WHO’s Dr. Mario Raviglione, who oversees the TB program, says a more rigorous adherence to the prevention strategy must be implemented across many sectors of health care.

“New collaborations, led by governments working alongside civil society and health professionals, if accountable, can halt the public health threat of drug resistance,” Raviglione said in a WHO press release.