Antimicrobial Resistance Part 1: Why more people are likely to die of infections in 2050

Recently, the World Health Organization (WHO) released a set of   health challenges the world will face this decade . Antimicrobial resistance made the list of 13. It is estimated that by 2050, there will be 10 million deaths annually due to antimicrobial resistance. Antimicrobial resistance occurs when microorganisms — bacteria, viruses, fungi and protozoa — change in response to drugs and develop immunity to them. This means that the drugs are less effective in combating them. Since they prevent and treat thousands of infections, the rise of antimicrobial resistance is a major public health threat.   [caption id=“attachment_7667751” align=“alignleft” width=“380”]  Representational image. Image source: Getty Images.[/caption]

Sizing up the threat

In 2016, 490,000 people developed multi-drug resistant tuberculosis (MDR TB). Resistance to  E. Coli, which causes urinary tract infections (UTIs) among other diseases, is widespread. In some countries, more than half of the population does not respond to treatment. Resistance to  K. Pneumoniae, which can cause bacterial pneumonia and UTIs, is also on the rise. In fact, the last-resort antibiotic carbapenem is also becoming ineffective in some countries. While antimicrobial resistance is natural and inevitable, we seem to have accelerated this trend by misusing drugs. Because they are easily available in many places, people tend to self-medicate. Case in point: many of us in India take antibiotics to treat fevers and straightforward ailments that only require over-the-counter antipyretics like paracetamol if that.

What about new drugs?

According to a report released recently by the WHO, “2019 Antibacterial Agents in Clinical Development”, antimicrobial drugs in the pipeline are insufficient to combat the rising threat of antimicrobial resistance. The 60 products in development will bring only limited advances over the current regimen and won’t address the most rapidly spreading resistant bacteria, that is gram-negative bacteria. The report says that this is because of declining private investment and innovation in the field. Most advances are being spearheaded by small- or medium-sized enterprises with larger players exiting the market. Previously, the WHO had released a list of 12 pathogens (including  E. coli  and  Klebsiella) that needed the most attention. Of the 60 products reviewed, 32 address these pathogens but their effectiveness against them is reportedly modest. More encouragingly, antibacterial treatments for tuberculosis and  C. difficile  (which causes diarrhoea) have shown better results. Further, drugs in the preclinical stages appear more promising and innovative in their molecular structures. However, it will be a decade before they are mainstream and affordable.

R&D in India

The Indian pharmacological company, Wockhardt Ltd, got approval for two new antibacterial drugs earlier this month. The Drug Controller General of India (DCGI) gave the green light to the drugs that will be used for acute bacterial skin issues, including diabetic foot conditions. One of the drugs, called EMROK, was tested on 500 patients across 40 facilities in India. It acts on Methicillin-resistant Staphylococcus aureus (MRSA): according to the WHO, those with MRSA are 64% more likely to die than those with a non-resistant form of the infection. These new drugs may offer some hope for people with the drug-resistant form of these diseases. The company did warn, however, of strong side-effects including kidney damage, lower blood platelet count and muscle pain. This means that the drug will have to be used sparingly and may not be appropriate for people with already compromised immunity. The road ahead will be challenging as more and more advanced technologies will be required to stay some steps ahead of the microorganisms. However, simple steps that prevent infections from spreading will slow down the advance of antimicrobial resistance. This includes maintaining good personal hygiene and access to clean water and sanitation. These straightforward public health ideas are the cornerstone of a healthy population. This is the first article in a multi-part series on antimicrobial resistance. For more information, read our article on   Klebsiella Infections_._ Health articles in Firstpost are written by myUpchar.com, India’s first and biggest resource for verified medical information. At myUpchar, researchers and journalists work with doctors to bring you information on all things health.