The Dreaded Reality

Antibiotic-resistant pathogens have been identified in virtually every corner of the world. Nevertheless, the exact scope of the problem remains unclear. The World Health Organization (WHO) estimates that of the 6.1 million cases of tuberculosis diagnosed worldwide in 2013, approximately 300,000 of them are multidrug- resistant tuberculosis (MDR-TB) defined as being not responsive to two of the standard treatments (isoniazid and rifampicin) (WHO 2014a). MDR-TB has been identified in all six WHO global regions: Africa, the Americas, Eastern Mediterranean, Europe, Southeast Asia, and the Western Pacific. Although treatment success rate for TB is about 86%, it drops to 48% with MDR-TB. More worrisome is the emergence of extensively drug-resistant TB (XDR-TB): TB that is resistant to standard treatments including the most effective second-line treatments. Nine percent of all patients with MDR-TB were also diagnosed with XDR-TB, and more than 100 countries reported cases of XDR-TB in 2013 (WHO 2014b). The data collected by WHO, however, do not paint a complete picture. Although the number of reported cases of MDR-TB in Southeast Asia, for instance, has grown from 68 in 2005 to 28,618 in 2013, it is not entirely clear if the dramatic change was a result of significant increase of antibiotic resistance or better diagnostic and reporting efforts. Indeed, data collection has remained a major hurdle in our attempt to gain a full understanding of the scope of the problem. Zumla et al. report that among 27 countries with a high burden of MDR-TB, “only 1% of new tuberculosis cases and 3% of previously treated cases are screened for [drug-resistant] tuberculosis by a laboratory” (Zumla et al. 2012: S229). The actual number of individuals who suffer from MDR-TB is likely significantly higher.

In addition to a lower treatment success rate, patients who suffer from antibiotic- resistant infections are also more costly to treat. On average, treatment for MDR-TB cost 3-100 times more (Koenig 2008: 894), and they last three to four times longer than drug-susceptible TB (leading to a greater chance of the TB spreading). A broad study commissioned by the Prime Minister of the United Kingdom and conducted by Jim O’Neill and the Wellcome Trust warns that unless drastic measures are taken, by 2050, antimicrobial-resistant diseases will claim ten million lives per year (O’Neill and Wellcome Trust 2014).

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