Drug resistance is a worldwide threat, warns report

BMJ 1994; 309 doi: (Published 29 October 1994) Cite this as: BMJ 1994;309:1109
  1. A Tonks

    Bacterial resistance to antibiotics is increasing worldwide, leading to the resurgence of infectious diseases such as tuberculosis and typhoid fever, says the British Parliamentary Office of Science and Technology in a report published this week. Drug resistance has spread rapidly among strains of Streptococcus pneumoniae, a common cause of pneumonia and meningitis. This organism is now resistant to penicillin in many places, including Alaska, South Africa, and Chile.

    In Britain resistance to penicillin is six times more likely than in 1989 and resistance to the alternative, erythromycin, has quadrupled. According to the report, scientists from the Public Health Laboratory Service are worried about the lack of alternative treatments for bacterial meningitis when conventional drug treatment fails.

    “Most antibacterial drugs do not build up in sufficiently high concentrations in cerebrospinal fluid (where the bacterial infection is located) to act effectively against this bacterium,” the report says. It warns that “alternative treatment strategies that may work for infections elsewhere in the body - for example using higher than normal doses … often fail when used against drug resistant meningitis.”

    Typhoid fever is now 20 times more likely to be resistant to drug treatment than in 1985; a quarter of cases now reported in Britain are resistant to four or more drugs, including the standard treatment chloramphenicol.

    The report blames inappropriate and profligate use of antibiotics for the rising rates of drug resistance but says that British doctors have more careful prescribing habits than doctors in other countries. In 1990 British doctors prescribed on average eight items to each patient; Spanish and American doctors prescribed twice as many, and patients in France were given an average of 38 items each.

    The British Society for Antimicrobial Chemotherapy reports that the number of prescriptions in England rose from 43 million in 1980 to 70 million in 1991. Overuse of antibiotics in hospitals is also a problem. The latest figures from the Public Health Laboratory Service show that nearly two thirds of hospital infections caused by staphylococci are now resistant to conventional drugs.

    Diseases Fighting Back - the Growing Resistance of TB and other Bacterial Diseases to Treatment is available, from the Parliamentary Office of Science and Technology, House of commons, 7 Millbank, London SW1P 3JA, price £10.

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