Elsevier

The Lancet

Volume 387, Issue 10014, 9–15 January 2016, Pages 168-175
The Lancet

Series
Access to effective antimicrobials: a worldwide challenge

https://doi.org/10.1016/S0140-6736(15)00474-2Get rights and content

Summary

Recent years have seen substantial improvements in life expectancy and access to antimicrobials, especially in low-income and lower-middle-income countries, but increasing pathogen resistance to antimicrobials threatens to roll back this progress. Resistant organisms in health-care and community settings pose a threat to survival rates from serious infections, including neonatal sepsis and health-care-associated infections, and limit the potential health benefits from surgeries, transplants, and cancer treatment. The challenge of simultaneously expanding appropriate access to antimicrobials, while restricting inappropriate access, particularly to expensive, newer generation antimicrobials, is unique in global health and requires new approaches to financing and delivering health care and a one-health perspective on the connections between pathogen transmission in animals and humans. Here, we describe the importance of effective antimicrobials. We assess the disease burden caused by limited access to antimicrobials, attributable to resistance to antimicrobials, and the potential effect of vaccines in restricting the need for antibiotics.

Section snippets

Antimicrobials are crucial to global health

Antimicrobials, particularly antibiotics, have been a mainstay of modern medicine for the last eight decades. Penicillin lowered mortality associated with pneumococcal pneumonia from 20–40% to 5%,1, 2, 3 and mortality from pneumococcal bacteraemia from 50–80%4 to 18–20%.3, 5, 6 In the past few decades, antibiotics have been used to support modern medical care, including the ability to do surgeries and organ replacements and treat cancer. The twin pressures of the remaining burden of infectious

Antibiotic consumption is increasing worldwide but limited access to these medicines is still an issue

Between 2000 and 2010, worldwide consumption of antibiotics by humans increased by 36%, with Brazil, Russia, India, China, and South Africa (BRICS) accounting for three-quarters of this increase despite collectively representing only 40% of the world's population.13 In BRICS countries, 23% of the increase in the retail sales volume was attributable to India where regulations to control over-the-counter sales of antibiotics are poorly enforced. Antibiotic consumption in hospitals is increasing

The loss of antibiotic effectiveness has important consequences for human health

The declining effectiveness of antibiotics in treating bacterial infections is now a worldwide phenomenon driven by ever-higher rates of antibiotic use, poor water, sanitation and public health measures to tackle infections, demographic changes with more elderly people, and increased use of medical procedures, hospital admissions, and tertiary care. The absence of sufficient access to basic public health and sanitation is a serious issue, particularly in countries where diarrheal disease is

Use of antibiotics in subtherapeutic concentrations is increasing in response to higher demand for animal protein worldwide

The use of antibiotics in animals at subtherapeutic concentrations for growth promotion (and ostensibly, disease prevention) is growing rapidly in response to a massive increase in the production of meat and animal products for human consumption. This process, a result of rising incomes, particularly in southeast Asia and China, is placing selection pressure for resistance to evolve. It is also threatening access to effective antibiotics for treatment of animal disease, essential both for food

The future of effective antibiotics

Worldwide, we are relying more heavily on antibiotics to ensure our medical, nutritional, and economic security while simultaneously causing the decline of their usefulness with overuse and ill-advised use. To avert or at least delay the crisis of a real postantibiotic era, we identify a few key priorities (panel 2). Specific policy actions and related strategies are discussed later in this series.

Antibiotic resistance is a nuanced and multisectoral problem that threatens to erase decades of

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