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The challenge of global antibiotic policy: Improving access and preventing excess

Posted on by Ramanan Laxminarayan
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Ramanan Laxminarayan,
Ramanan Laxminarayan,
Director and Senior Fellow, Center for Disease Dynamics, Economics & Policy

Antibiotic resistance has been making headlines lately, and for good reason: the identification of new resistance genes, rising resistance rates and widespread public misunderstanding of the problem are all causes for concern about the growing proliferation of drug-resistant “superbugs.”

But in many low- and middle-income countries, millions of people lack access to antibiotics and common infections like pneumonia pose a far greater threat than any superbug. In a new Lancet study, researchers at the Center for Disease Dynamics, Economics & Policy (CDDEP), working with collaborators in the UK and South Africa, estimated that in 101 countries, improved access to antibiotics could avert approximately three-fourths of the deaths of children under five caused by pneumonia alone each year—averting about 455,000 deaths annually.

Lack of access to antibiotics is further complicated by rising resistance rates. Overuse of these powerful drugs can lead to the development of drug-resistant bacteria, which renders certain antibiotics powerless to fight infection. Newer, effective drugs may be available, but are usually unaffordable and out of reach for poorer populations. The Lancet paper estimated that almost a quarter-million neonatal deaths (214,000) each year across the globe occur due to untreatable sepsis from infections caused by drug-resistant bacteria.

Vaccine coverage could prevent the need for antibiotics in the first place; the Lancet study also shows that giving the pneumococcal conjugate vaccine (PCV) to all children under age five would bring about a 47 percent reduction in the number of days kids need to take antibiotics for infections caused by Streptococcus pneumoniae.antibiotic resistance

The best way low- and middle-income countries can combat antibiotic resistance is by improving water quality and sanitation practices, implementing innovative financing mechanisms for drugs, launching public education campaigns about using antibiotics appropriately, and limiting use of antibiotics for growth promotion in livestock. In an accompanying commentary to the Lancet series, health ministry officials from Kenya, India, Mozambique, and South Africa discuss steps taken in their countries to create effective national policy for combating antibiotic resistance, and laud CDDEP’s contributions through the Global Antibiotic Resistance Partnership. These successes are detailed in CDDEP’s State of the World’s Antibiotics: 2015 report, released in September.

Increasing affordable access and limiting antibiotic resistance are complementary goals; together they provide a comprehensive solution to the challenge of ensuring appropriate access to and use of antibiotics. Access to effective antibiotics should be a global priority, and must be balanced with policies that limit the dangerous trends of excess and inappropriate use that have caused the current crisis of resistance.

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