On September 15 in Baku, Azerbaijan, at the WHO Regional Committee for Europe, 53 countries discussed adopting a new European strategic action plan on antibiotic resistance. Developed by the WHO Regional Office for Europe following extensive consultation with experts and policy-makers and based on the latest research, the action plan builds on the momentum created by World Health Day 2011, with its slogan of “No action today, no cure tomorrow”.
“We know that now is the time to act. Antibiotic resistance is reaching unprecedented levels, and new antibiotics are not going to arrive quickly enough,” said Zsuzsanna Jakab, WHO Regional Director for Europe. “Antibiotics are a precious discovery, but we take them for granted, overuse and misuse them: there are now superbugs that do not respond to any drug, and that is why the action plan has won so much support.”
Every year in the European Union it is estimated that over 25 000 people die of antibiotic-resistant bacterial infections, mostly acquired in hospitals. This is despite the major progress achieved and efforts made by the European Union, particularly in surveillance and awareness. In the wider WHO European Region, which encompasses 53 countries, the full number is not known as data are not always available, but the signs suggest that the situation is even worse. Doctors and scientists across the Region fear that with the reckless use of antibiotics, resulting in the emergence and spread of antibiotic-resistant infections, we could return to a pre-antibiotic era where simple infections do not respond to treatment, and routine operations and interventions become life-threatening.
About the Action Plan
The action plan highlights the real and urgent risks of lifesaving antibiotics losing their healing power, and stresses the need to reduce complacency, overuse and misuse. Such an effort calls on everyone, from the public to physicians to politicians, drug companies and veterinarians, to use antibiotics properly and responsibly.
The European strategic action plan on antibiotic resistance identifies seven key areas where action must be taken to ensure that Europeans are safe. They are:
• national multisectoral coordination for the containment of antibiotic resistance;
• surveillance of antibiotic resistance and antibiotic consumption;
• strategies for the rational use of antibiotics and for strengthened surveillance of antibiotic consumption;
• infection control in hospitals and clinics;
• the development and spread of antibiotic resistance in the veterinary and agricultural sectors;
• innovation and research on new drugs and technology; and
• awareness, patient safety and partnership.
Improvement Needed in Coordination and Collaboration Among Countries
Several European countries have shown what can be done to combat antibiotic resistance but, in many countries, there are no national regulations on antibiotic usage, healthy animals are given antibiotics as growth promoters or to prevent disease, and some commercial companies engage in inappropriate promotion. In too many countries, antibiotics can be bought over the counter by the general public and farmers without a prescription and used at will. Further, doctors often prescribe them too easily or inappropriately and people take them to treat viral infections such as influenza and the common cold, which many (mistakenly) believe to be treatable with antibiotics.
An informal survey of 21 countries in the eastern parts of the European Region indicated that, in 14 of them, buying antibiotics over the counter is common practice. Only 7 out of the 21 have a national plan of action on antibiotic resistance, and 7 out of 21 have a national coordinating committee in place. Less than half the countries surveyed have national guidelines on hand hygiene in health care settings, and only a third have a national surveillance system and database on antibiotic resistance.
Awareness campaigns, such as the European Antibiotic Awareness Day organized every November by the European Centre for Disease Prevention and Control, have successfully addressed the overuse of antibiotics, and several countries can demonstrate a steady decrease in antibiotic usage resulting in a decrease in resistance. Stringent infection prevention and control programmes in health care settings, starting with simple hand hygiene, significantly reduce the occurrence of, for example, methicillin-resistant Staphylococcus aureus (MRSA), the much-feared hospital bacterium.
The need for new antibiotics is growing as resistance spreads in European countries, making infections such as those in the bloodstream very difficult to treat. For instance, an increasing number of bacteria are carrying a gene that enables them to produce an enzyme called New Delhi metallo-ß-lactamase-1(NDM-1) which makes them resistant to a broad range of antibiotics, including the carbapenems, the last resort antibiotics for many severe bacterial infections. Less than a handful of antibiotics are currently in the pipeline to combat antibiotic-resistant bacteria, and the worldwide spread of severe resistance genes is considered a nightmare scenario. Furthermore, multidrug-resistant tuberculosis, a heavy burden in the eastern part of the Region, continues to spread, threatening the lives of many.