The World Health Organisations says: 'The world is headed for a post-antibiotic era, in which common infections and minor injuries can once again kill.'
Pneumonia will again become a feared killer, surgery risky and diarrhoea fatal if urgent action is not taken to preserve the power of current antibiotics as well as develop new ones, the World Health Organisation has warned on Wednesday.
In its first investigation of the extent of antimicrobial resistance across the world, the WHO said we are facing a huge threat to public health, which could affect anybody of any age.
No country is immune, as bacteria and viruses resistant to drugs travel the globe with ease.
In the UK, as elsewhere, there is increasing concern about infections from Klebsiella pneumoniae, bacterium carried in the intestines which has become resistant to the last line of antibiotics available, the carbapanems. In fragile patients on intensive care wards and newborn babies, these infections can be fatal. Meanwhile, sexually transmitted gonorrhoea is on the increase and is also resistant to the last-resort antibiotics used to treat it.
"Without urgent, coordinated action by many stakeholders, the world is headed for a post-antibiotic era, in which common infections and minor injuries which have been treatable for decades can once again kill," said Dr Keiji Fukuda, WHO's assistant director general for health security.
"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."
Wednesday's report is the first to gather comprehensive data from the WHO on antibiotic resistance and has information from 114 countries. Although the data is more complete in some regions than in others, it is clear that drug-resistant strains of bacteria and viruses are common and that trying to preserve the efficacy of current antibiotics is a losing battle.
"We know that the pathogens are everywhere. They were here before humanity," Dr Carmen Pessoa Da Silva, team leader on antimicrobial resistance at WHO, told the Guardian. "It is not a problem of a single country or single region. It is a problem that belongs to the entire planet. This is important. No single country even with the best possible policies in place can address this issue alone. We need all countries to get together and discuss and put in practice possible solutions."
The report raises concerns about drug-resistant tuberculosis, which is spreading and requires more than a year of treatment with combinations of antibiotics that are unaffordable in some countries. It also looks at the rise of treatment-resistant strains of HIV, which is common in Europe and north America.
But the report's main focus is seven bacteria responsible for common infections that are now sometimes life-threatening because of antibiotic resistance. The most worrying findings are the worldwide drug-resistant K pneumoniae, the treatment failures in gonorrhoea in 10 countries – including the UK – and the widespread resistance to fluoroquinolones – one of the most widely used antibacterial drugs for the treatment of urinary tract infections caused by E coli.
New drugs are not on the horizon. There have been no new classes of antibiotics for 25 years, said Dr Danilo Lo Fo Wong, senior adviser on antimicrobial resistance to WHO Europe.
Pharmaceutical firms cannot cover the costs of research and development, because new antibiotics have to be used sparingly for fear of resistance developing – and when that begins, they have a short lifespan. "New antibiotics coming on to the market are not really new," Lo Fo Wong said. "They are variations of those we already have." That means that bacteria are likely to develop resistance to them that much sooner.
"We see treatment failure and we see people die because they are not treated in time," he said. "In some parts of the world, it is about availability." But in others, patients are treated with one antibiotic after another to try to find something that works, increasing the risk to them because they become more ill and also further driving resistance. Some countries in Europe do not automatically carry out tests to establish what the infection is, especially if there are additional costs to the hospital or patient.
The WHO urges all countries to be more sparing in their use of antibiotics in humans and in animals and improve hand hygiene, which has been credited with reducing the numbers of cases in the UK of the "superbug" MRSA – staphylococcus aureus – that is resistant to the antibiotic methicillin.
The medical charity Médecins Sans Frontières said a global plan for the rational use of affordable antibiotics was urgently needed.
"We see horrendous rates of antibiotic resistance wherever we look in our field operations, including children admitted to nutritional centres in Niger, and people in our surgical and trauma units in Jordan," said Dr Jennifer Cohn, medical director of the MSF Access Campaign. "Countries need to improve their surveillance of antimicrobial resistance, as otherwise our actions are just a shot in the dark; without this information, doctors don't know the extent of the problem and can't take the right clinical decisions needed.
"Ultimately, WHO's report should be a wake-up call to governments to introduce incentives for industry to develop new, affordable antibiotics that do not rely on patents and high prices and are adapted to the needs of developing countries."
British experts agreed on the urgency of the problem. "The world needs to respond as it did to the Aids crisis of the 1980s," said Laura Piddock, professor of microbiology at University of Birmingham and director of the campaigning group Antibiotic Action. "To do this, we need to be ambitious to succeed."
Mandatory and funded global surveillance and public education campaigns were important, she added, "but these are just starting points. We still need a better understanding of all aspects of resistance as well as new discovery, research and development of new antibiotics." However, UK government funding for antibiotic research had dwindled, Piddock warned.
Prof Martin Adams, president of the Society for Applied Microbiology, also called for more research into how resistance develops in both human and animal antibiotic use. "Even if there are new antimicrobial drugs brought to market, we will still face the spectre of resistance unless we can learn how to minimise or slow its development," he said.