Superbugs

UK raises alarm on deadly rise of superbugs

Britain to call for G8 action against spread of drug-resistant bacteria by clamping down on overuse of antibiotics

The Guardian,

11 June, 2013

Britain is to urge the G8 to take action against the spread of drug-resistant microbes as medical and veterinary experts warn that co-ordinated international action is needed to prevent soaring rates of potentially lethal infections turning into a public health catastrophe.

David Willetts, the science minister, will propose far-reaching measures that would clamp down on the overuse of antibiotics by GPs and hospital doctors. He will also try to restrict usage on farms and fisheries, where the drugs are blended with feed to boost yields.

Willetts will push for a consensus on ways to ramp up the discovery of new drugs to fight bacteria, speed their approval and delivery to patients, and strengthen cross-border surveillance for emerging resistant strains.

"Across the G8, we should regard the spread of antibiotic resistance as a global challenge that is up there with climate change, water stress and environmental damage, and there are genuine policy consequences that follow from that," Willetts told the Guardian ahead of Wednesday's meeting of science ministers at the Royal Society in London.

Drug-resistance is an inevitable consequence of antibiotics. The drugs wipe out susceptible infections but leave resistant organisms behind. The survivors multiply and, in time, can become immune to even the strongest antibiotics. Though improved surveillance and hygiene has reduced levels of life-threatening MRSA and C difficile "superbugs" in hospitals, resistant strains are on the rise.

In Britain, doctors see ever more resistant strains of TB, E coli and Klebsiella, which causes pneumonia. Some 80% of gonorrhoea is now resistant to the frontline antibiotic tetracycline. Of serious concern is the rise of resistance to powerful drugs called carbapenems, the antibiotics of last resort. The first few cases were detected in Britain in 2003, but since then the numbers have soared to 217 cases in the first six months of 2011.

Willetts has asked England's chief medical officer, Dame Sally Davies, to brief the meeting after she warned in a March report that untreatable infections posed a "catastrophic threat" to the population.

Davies has asked for antibiotic resistance to be added to the government's national risk register, a move that makes the issue easier to raise abroad.

Davies has already briefed senior figures in Whitehall on the threat and has rallied international experts and chief medical officers in other countries to push the EU and World Health Organisation to beef up their action plans. Ultimately, she seeks a UN treaty that would ban antibiotics in food production, such as fish farming and fruit growing, streamline the regulatory process for licensing new drugs, and commit nations to educational drives that instil more prudent usage of the drugs."The soaring number of antibiotic-resistant infections poses such a great threat to society that in 20 years' time we could be taken back to a 19th century environment where everyday infections kill us as a result of routine operations," Davies said.

The government is to publish its antimicrobial resistance strategy next month. It will set out plans to slow the emergence and spread of drug-resistant bugs, maintain the effectiveness of existing drugs and bolster support for researchers.

The G8 meeting is seen as an opportunity to urge other nations to follow suit. "We can't tackle the problem on our own and urgently need coordinated international action," Davies said.

New research published by the Guardian also reveals that GPs in some areas are almost three times more likely than elsewhere to prescribe antibiotics. Keith Ridge, NHS England's chief pharmaceutical officer, said he was aware of this worryingly wide variation and keen to see if lessons from hospitals' improved prescription of antibiotics could now be applied to England's 8,500 GP practices.

Davies said: "Our proposals are far-reaching, including stimulating development of new drugs through some sort of public-private partnership, cutting down the antibiotics given to farm animals and used in medical practice, making infection surveillance go across borders, and getting countries to sign up to their own education programmes."

Dr Clare Gerada, chair of the Royal College of GPs, said some GPs were over-prescribing antibiotics to patients simply because they were overworked, increasing the long-term risks.

"I'm not blaming them. I've been there myself, at the end of a very busy clinic. If you're running over time and have a queue of patients waiting, sometimes the least worst option is to give a prescription, even though you know that medically it's of little value," she said.

In the past, drug resistance was countered by a steady flow of new antibiotics on to the market. Over the past 60 years, the pharmaceutical industry released three generations of drugs, starting with natural penicillins, then synthetic penicillins, and most recently the carbapenems. But the supply has dried up. The number of new drugs in the pipeline is at an all-time low as research was shelved in favour of more profitable drugs in the 1990s, coupled with the difficulties in discovering new medication.

Meanwhile, other experts are warning that increasing use of the drugs on farms poses a threat to people. Recent studies have shown that the overuse of antibiotics in intensive livestock farming could lead to the evolution of strains of dangerous bacteria, including MRSA, E coli and salmonella, that are resistant to some of the strongest antibiotics. An increasing body of evidence shows they can spread from farms to farm workers and their families as well as to consumers through affected meat.

Farms in the UK are not supposed to use antibiotics routinely, as happens in many non-EU countries, but the Guardian has uncovered clear problems with this regime as the current monitoring of usage does not give government regulators enough information to decide how the drugs are used in practice.

Antibiotics are routinely dumped into animal feed in the US – where 80% of antibiotics are used for animals – and Latin America and other regions because they help animals put on weight faster.

Zac Goldsmith, the Conservative MP who has tabled a motion in parliament for stronger regulation, said dealing with antibiotics on farms was as urgent as changing prescribing practices and hygiene in hospitals. "We need to phase out the routine use of antibiotics on intensive farms altogether, starting with those most important in human medicine."

John Rex, vice-president and medical director for infection at Astra Zeneca, said necessary changes were planned for the regulatory process too. "The idea that we as a society should wait for these cases before we start drug development is a non-starter. Bacterial infections can kill you in a couple of days, We are now treating young women with complicated urinary tract infections with intravenous antibiotics, not a pill. We are seeing strains of gonorrhoea for which we have no antibiotics, not just a small number, not just one, but zero," he said.

This summer, the European Medicines Agency will overturn this system by allowing trials of antibiotics to be done differently. Trials will no longer need to recruit people with the same infection in the same place.

Instead, they can pool people with infections at any body area, such as the lungs, stomach, or skin, as long as they are caused by the same bug. The shift means trials can be run much faster, said Rex. The US Food and Drug Administration is expected to make similar changes to its guidelines.

Drug-Resistant Gonorrhea Rises In Great Britain

Forms of gonorrhea that don't respond to the last line of antibiotics have rapidly spread in Great Britain, expanding the reach of drug-resistant disease

NPR,

11 June, 2013

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The number of gonorrhea cases with decreased sensitivity to the front-line drug cefixime increased by nearly six times from 2004 to 2011 in England and Wales, a team from the U.K.'s Health Protection Agency reported Tuesday in The Lancet Infectious Diseases.

Drug-resistant gonorrhea is a growing trend worldwide, with cases rising in Asia, North America and Europe. Japan has even documented a superresistant strain of gonorrhea that can thwart all available drugs.

Sixty years ago, doctors had a large arsenal against gonorrhea, including penicillin, ampicillin, tetracycline and doxycycline. But one by one, each of those antibiotics stopped working. Now there are only two drugs left: cefixime, which is taken orally, and ceftriaxone, which is injected into muscle.

Last summer, evidence emerged that cefixime had stopped working against gonorrhea in the U.S. The data were so worrisome that the Centers for Disease Control and Prevention sounded the alarm and issued new guidelines for treating the sexually transmitted disease. Then in January, Canada documented the first case of cefixime-resistant gonorrhea.

Gonorrhea, aka "the clap," is the second-most-common sexually transmitted disease in the U.S., with more than 300,000 cases reported in 2011.

In the current study, epidemiologists tested drug sensitivity for more than 7,000 gonorrhea cases in England and Wales. Strains that showed signs of resisting cefixime steadily increased from 2004 to 2010, when 17 percent of cases didn't respond to normal doses of the medication. This percentage then fell to 10.8 in 2011.

The gonorrhea cases that didn't respond well to cefixime also showed resistance to ceftriaxone.

These two drugs are in the same class of antibiotics. So many scientists worry that once the bacterium conquers one of them, it will eventually knock out the other, too.

The world doesn't have any backup treatments for gonorrhea. Once this class of antibiotics is gone, we've got a big problem