A new study is sounding the alarm about the excessive consumption of antibiotics, especially in emerging countries, and the resulting bacterial resistance.
The numbers are head-spinning: global consumption of antibiotics increased by 65% between 2000 and 2015, boosted by exploding use in middle and low-income countries. For researchers, this increase represents a threat to global health. They point out that “resistance to antibiotics, driven by the consumption of antibiotics, is a growing threat to global health”.
Published on Monday, March 26, 2018 in the US journal Proceedings of the National Academy of Sciences (PNAS), this study, based in part on projections explains that “the total overall consumption of antibiotics in 2015 was estimated at 42.3 billion doses daily “. In the 76 countries studied, antibiotic uptake increased from 21.1 billion daily doses in 2000 to 34.8 billion in 2015. Correlated with the increase in their Gross Domestic Product (GDP), the level of Antibiotic consumption has particularly increased in low- and middle-income countries (LMICs): + 114% in 16 years, reaching 24.5 billion specific daily doses.
Highest rate of consumption in low- or middle-income countries
Some LMIC countries have exceeded the antibiotic consumption rate of high-income countries. In 2015, Turkey, Tunisia, Algeria and Romania were among the six countries with the highest rates of antibiotic use, while in 2000, the top five were all high-income countries. Consumption is lower for High Income Countries (HICs), with 10.3 billion daily doses. Between 2000 and 2015, the increase was only 6%. The rise was only marginal in the three leading consumer countries in high-income nations, the United States, France and Italy, says the study.
For Eili Klein, a researcher at the Center for Disease Dynamics, Economics & Policy and one of the authors of the study, this increase means “better access to necessary medicines in countries with many diseases that can be effectively treated with antibiotics “. But this positive point is quickly obscured by the researcher. “As more and more countries gain access to these drugs, these (consumption) rates will rise (…) leading to higher rates of antibiotic resistance,” he said.
Antibiotic resistance, how does it work?
Antibiotics attack bacteria in different ways to cause their destruction. They can either destroy their membranes or, for example, inhibit their DNA synthesis. The efficacy of antibiotics has motivated their important and repeated use in human and animal health worldwide. Problem: Misuse of antibiotics (unjustified treatments, too long, or too short) created a selection (and multiplication) of bacterial populations equipped with a “defense system” against the molecule. These bacteria are said to be resistant: they are no longer killed by the drug.
Punctual at first, the phenomenon of resistance has become massive and disturbing. Bacteria are now multi-resistant (they are resistant to several antibiotics) and some are even toto-resistant, that is to say, resistant to almost all the antibiotics available to doctors. Scientists are now concerned.
Acquired antibiotic resistance can result from several mechanisms
- A genetic mutation on a chromosome of the bacterium itself, which causes a modification of the “target point” of the antibiotic: it can no longer bind to the bacteria to destroy it. When the bacterium replicates, it transmits the resistance gene to its clones.
- A transfer of genetic material: when a resistant bacterium comes into contact with a bacterium that is not, even if it is from another species, it can transmit its resistance gene.
In both cases, if the antibiotic is used massively, it plays its role of “selector”: resistant bacteria multiply and sensitive bacteria are eliminated.
Ten million deaths per year by 2050 due to bacterial resistance
Bacterial resistance is responsible for 700,000 deaths a year worldwide according to a group of international experts formed in 2014 in the UK. And the future is dark: “Projections of overall antibiotic consumption in 2030, assuming no policy change, are up to 200% higher than the 42 billion daily doses determined in 2015” .
Antibiotic resistance could cause 10 million deaths a year by 2050, according to a recent British study.