Future impacts of antibiotic resistance

Why does this matter?Antibiotic resistance does not only influence

health in the global population at present, but has the potential to cause devastating worldwide consequences in the future

Recognition of these possible future impacts helps to emphasise the need for drastic change in the prescription and usage of antibiotics

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Post-antibiotic eraIt is estimated that if antibiotic resistance is not

tackled, 10 million people could die per year of curable diseases by 20501

The economy could lose billions of dollars more per year due to increased loss of public health goods as well as the huge costs associated with dealing with this issue

The world may enter a post-antibiotic era, whereby previously treatable infections and injuries can become deadly once more2

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Treatment failuresMany drugs, after development, had negligible or

very low failure rates and generally succeeded in curing various life-threatening diseases2

With the emergence of antibiotic resistance, patients worldwide have failed to respond to previously effective antibiotic treatments2

This includes the emergence of multidrug-resistant tuberculosis, Plasmodium falciparum, methicillin-resistant Staphylococcus aureus (MRSA) and so on3

Drugs such as fluoroquinolones, carbapanems, cephalosporins and so on are now ineffective in more than half of people in countries all around the world2,3

There has also been rapidly increasing resistance to drugs used to treat tuberculosis, malaria, influenza, gonorrhea, urinary tract infections and so on2

With the rapid spread of antibiotic resistance, these diseases will soon become extremely difficult to manage and can cause increased disability and death2,3

In terms of morbidity and mortality, diseases are expected to vary across countries

Malaria is expected to be the most significant in Asian countries, while tuberculosis is expected to severely impact Russia1

MRSAThis is predicted to become a huge public health issueThe scope of this resistance will extend to more

settings – hospitals used to be the only settings where MRSA was found, but more community outbreaks can be expected4

These outbreaks may happen in people who lack traditional risk factors for MRSA4

MRSA prevalence in the US community may reach 25% in the next 10 years, with even higher rates within hospital settings4

Loss of control over infection

If antibiotic resistance continues, global health systems will lose control over many infectious diseases

The rates of hospitalisation and infection will be elevated, and alternative treatments will need to be sought

Longer hospitalisation periods and greater extent of disability3

Death rates from infectious diseases will inevitably increase

Resistance mechanismsThere is the potential for new resistance mechanisms to

emerge, and for resistance rates as a whole to increase4

Multiresistant streptococci, staphylococci and enterococci will potentially cause substantial illness and be difficult to combat, especially in parts of the world that have not yet implemented strict control measures4

Vancomycin-resistant antibiotics may become endemic on a global scale4

A huge number and range of antibiotics will be rendered useless in the treatment of a large number of diseases

Development of antibiotics

There have been no new antimicrobial classes developed for gram-negative bacteria for decades4

Vaccines have not been widely effective4

Fluoroquinolones used to be widely effective against multiple infections, but this is not the case anymore. There have also not been any new class of antimicrobial agents to function as a substitute for them4

Several new antimicrobial drugs with different mechanisms of action have failed in phase three trials4

Antibiotics are being rendered useless very quickly but no novel antibiotics have been found to be successful – this is very concerning and can have devastating implications for the health of global populations

Medical proceduresAntibiotics have commonly been used to treat infections

that appear secondary to procedures such as caesarean child birth, organ transplants, chemotherapy and so on1,2

With the growing resistance against antibiotics, these procedures will be able to cause diseases which may soon be rendered incurable1

Therefore, these procedures can become much more dangerous, and are expected to cause higher rates of persistent infection and death1

This will impact not only wealthier countries where such procedures are common, but also middle income countries that are trying to implement health systems1

Costs of antibiotic resistance

There will be a significant loss of public health goods due to antibiotics being rendered useless by growing resistance, and substantial economic losses

Patients infected with drug-resistant bacteria generally suffer from longer-lasting and more severe infections, and as such require extended hospitalisation and increased treatment and care resources 2,4,5

Broad-spectrum antibiotics are being used increasingly for empirical therapy of many common infections – these agents are often costlier, and have more toxicity towards protective microflora. They are also occasionally less effective5

Alternative therapies and treatments are required, and these can be expensive to develop or implement

Therefore, it can be seen that antibiotic resistance is a pressing issue that can have severe, negative consequences on numerous countries worldwide.

It is essential to understand these impacts in order to grasp the importance of changing attitudes towards antibiotic development, prescription and usage.

References 1. Dovey D. If We Don’t Do Something About Antibiotic Resistance, 10 Million People

Could Die Each Year [Internet]. Medical Daily. 2015 [cited 4 April 2016]. Available from: http://www.medicaldaily.com/antibiotic-resistance-will-kill-10-million-people-year-2050-report-shows-grim-future-316730

2. WHO | WHO’s first global report on antibiotic resistance reveals serious, worldwide threat to public health [Internet]. Who.int. 2016 [cited 4 April 2016]. Available from: http://www.who.int/mediacentre/news/releases/2014/amr-report/en/

3. Antimicrobial resistance [Internet]. World Health Organization. 2016 [cited 4 April 2016]. Available from: http://www.who.int/mediacentre/factsheets/fs194/en/

4. Harbarth S, Samore M. Antimicrobial Resistance Determinants and Future Control. Emerg Infect Dis. 2005;11(6):794-801.

5. Eliopoulos G, Cosgrove S, Carmeli Y. The Impact of Antimicrobial Resistance on Health and Economic Outcomes. Clinical Infectious Diseases. 2003;36(11):1433-1437.