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The first patient with pneumonia resistant to all antibiotics was recorded in South Africa last year, raising the terrifying possibility of a “post-antibiotic era”.

The 86-year-old man was in hospital for heart surgery when doctors discovered that his klebsiella pneumonia bacteria was resistant to antibiotics.

Reporting on his case, Health director-general Precious Matsoso this week des-cribed the emergence of super-bugs immune to medicines as “worse than Aids”, and urged an expert meeting currently under way in Cape Town to advise the government.

Without antibiotics, people could once again start dying from infections, and procedures such as organ transplants would be impossible.

A Ministerial Advisory Committee, including representatives from the public and private sectors, is expected to be established soon to help the Health Department deal with drug resistance, focusing on tuberculosis, HIV and malaria medicine, said Matsoso.

One South Asian child dies every five minutes from drug-resistant bacteria, while about 25 000 Europeans die every year from similar infections.

About half of all antibiotic prescriptions are estimated to be unnecessary, and this is driving the development of drug-resistant “super-bugs”.

In India, Thailand and Vietnam, people can buy antibiot-ics without a prescription.

Dr Carmen Pessoa-Silva, who heads the World Health Organisation’s anti-microbial resistance programme, told the meeting it was a fallacy that the world needed more medicines.

“We need to consider other alternatives to drugs, such as vaccines and better infection control,” she said.

The World Health Assembly is expected to discuss antimicrobial resistance when it meets next month.

Groote Schuur Hospital recently introduced an antimicrobial resistance team aimed at cutting down on the unnecessary prescription of antibiotics.

“There has been a 19.6 percent decrease in prescriptions for antibiotics in the past year, resulting in a saving of R250 000,” said Professor Marc Mendelson, co-chair of infectious diseases at the University of Cape Town.

Dr Ramanan Laxminarayan, from the Public Health Foundation in India, said that in the past, resistance to antibiotics typically started to develop about 15 years after the introduction of the medicine, as the micro-organisms adapted to evade antibiotics, antifungals, antivirals and antimalarials.

“But now resistance is picking up pace. By the time new drugs get to our countries (from Europe and the US, where they are developed), there could already be resistance and we won’t be able to use them,” he warned.

Mendelson said the over-use of antibiotics was highest in agriculture, where they were mixed into the food of animals to boost their growth.

Research shows that drug resistance can pass relatively easily from animals to humans.

Hospital patients are particularly vulnerable to drug-resistant infection because their immune systems are weak and some have open wounds or are on drips or ventilators, easy sites for infection. Poor hand-washing by health workers is a big culprit in spreading infection.


What is antimicrobial resistance?

Antimicrobial resistance is resistance of a microorganism to antimicrobial medicine to which it was originally sensitive.

Resistant organisms (including bacteria, fungi, viruses and some parasites) are able to withstand attack by antimicrobial medicines such as antibiotics, antifungals, antivirals and antimalarials, so that standard treatments become ineffective and infections persist, increasing the risk of its spreading to others.

The evolution of resistant strains is a natural phenomenon that happens when micro-organisms are exposed to antimicrobial drugs, and resistant traits can be exchanged between certain types of bacteria.

The misuse of antimicrobial drugs and poor infection-control practices also accelerate this phenomenon.

Health-e News Service