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Israeli infectious disease expert: WHO slow recognize global threat of bacteria resistance
By JUDY SIEGEL-ITZKOVICH
05/01/2014
 
There is nothing new in the World Health Organization’s release of a first global report on bacterial resistance to existing antibiotics, says Prof. Yehuda Carmeli, the Health Ministry’s head of the national unit for the prevention of infection and resistance to antibiotics.

“What is new,” he told The Jerusalem Post on Thursday, “is that the WHO is now willing to raise the issue worldwide and recognizes it as danger to world.”

Carmeli, who works at the Sourasky Medical Center in Tel Aviv, said that high-level officials in the UN organization understand that the WHO “has no choice but to get involved because of the serious global threat to public health. I myself made several attempts to get them involved, but they regard their mission as being to the underdeveloped countries and thought bacterial resistance with antibiotic overuse is more an issue for developed countries.

“But many professionals have said recently that if the WHO doesn’t deal with this major issue, they would decide no longer to work with the WHO. In the last few years, the organization has changed its mind. I don’t know exactly why. In the past, only a half-time WHO employee has dealt with this problem, but now there are several,” said Carmeli.

The problem of “superbugs,” which develop because of antibiotics that are improperly or unnecessarily used, is getting worse every day, he said. “Many people around the world die because there is no antibiotic that is effective in killing the bacteria.”

Carmeli said that a major problem is that new, more effective antibiotics are not being developed because of financial considerations. People with infections take pills for a week or two and then the infection clears up, meaning they have no long-term use. It costs about a billion dollars to invest in the development of a single antibiotic.

He added that “the companies are unwilling to do this, as antibiotics are not significantly profitable. They prefer developing drugs for chronic diseases that are taken for life,” and pointed out that “patients who die due to resistance have no lobby.”

The European Union has invested only €600,000 on the topic over the past 15 years, and the US National Institutes of Health have spent even less, he said.

Excess or improper prescriptions of antibiotics occurs not only in doctors’ offices but also in hospitals, where infectious diseases are transmitted among patients. Carmeli said he has seen “some improvement” in recent years, but it isn’t enough.

“The Health Ministry has issued guidelines and set standards, but they are not always carried out because the hospitals and health funds lack budgets for specialists who devote their time to supervision, writing protocols for patients, computerization and teaching of medical staff. Individual doctors worry about their own patients, not the whole picture. Everybody agrees now that there is a major problem, but the Treasury doesn’t fund such personnel. Because the Finance Ministry doesn’t provide budgets, people die.”

Carmeli said that the Health Ministry set up his infection prevention unit a few years ago, during an outbreak of the intestinal bacteria called Klebsiella pneumoniae.

“But high-level personnel are needed. If I were finance minister, I would make sure that every hospital and health fund in the country has the ability to deal with controlling antibiotics. It would cost tens of millions of shekels, so it doesn’t get done. But when people die, it costs the economy much more.”

The infectious diseases expert said he did not know what would be the result of the WHO’s new report, which was issued by Dr Keiji Fukuda, the WHO’s assistant director-general for health security.

“Without urgent, coordinated action by many stakeholders, the world is headed for a post-antibiotic era, in which common infections and minor injuries that have been treatable for decades can once again kill,” Fukuda declared. “Effective antibiotics have been one of the pillars allowing us to live longer, live healthier and benefit from modern medicine. Unless we take significant actions to improve efforts to prevent infections and also change how we produce, prescribe and use antibiotics, the world will lose more and more of these global public health goods and the implications will be devastating,” he added.

Resistant bacteria has spread over the world and is a major cause of hospital-acquired infections such as pneumonia, bloodstream infections and infections in newborns and intensive-care unit patients.

In the 1980s, when fluoroquinolones antibacterial drugs were introduced to treat urinary infections caused by E. coli, resistance to the drug was unknown, but now it is very widespread.

Today there is failure in the treatment of gonorrhea with third-generation cephalosporin antibiotics too.

As a result of resistance, the WHO said, people are sick for longer and the risk of death increases. Resistance increases the cost of health care with lengthier stays in hospital and more intensive care required.
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