E-DRUG: antimicrobials in the food chain & resistance
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[sorry, we missed these two press releases of WHO. Better late
than never? WB]
WHO/43 13 June 2000
WHO ISSUES NEW RECOMMENDATIONS TO PROTECT
HUMAN HEALTH FROM ANTIMICROBIAL USE IN FOOD
ANIMALS
The World Health Organization (WHO) has released global
principles aimed at mitigating the risks related to the use of
antimicrobials in food animals. Among other uses, antimicrobials
kill bacteria in animals used for human food. The new
recommendations, agreed at a WHO experts� meeting in Geneva,
come amid growing concern over the misuse and overuse of these
drugs.
The new recommendations are designed for use by governments,
veterinary and other professional societies, industry and academia.
Some of the most important measures included in the new "Global
Principles for the Containment of Antimicrobial Resistance due to
Antimicrobial Use in Animals intended for Food" are:
obligatory prescriptions for all antimicrobials used for disease
control in food animals termination or rapid phasing-out of the use
of antimicrobials for growth promotion if they are also used for
treatment of humans in the absence of a public health safety
evaluation creation of national systems to monitor antimicrobial
usage in food animals pre-licensing safety evaluation of
antimicrobials with consideration of potential resistance to human
drugs monitoring of resistance to identify emerging health problems
and timely corrective actions to protect human health guidelines for
veterinarians to reduce overuse and misuse of antimicrobials in
food animals
Overuse and misuse of antimicrobials in food animals contribute to
the emergence of resistant forms of disease-causing bacteria.
Such resistant bacteria can be transmitted from food animals to
humans, primarily via food. Infections can result that are difficult to
cure because the resistant bacteria do not respond to treatment
with antimicrobials.
An example is the emergence of antimicrobial-resistant Salmonella
bacteria in food animals in Europe, Asia and North America which
have caused diarrhoea, sepsis (blood-poisoning) and death in
humans. Another example is Enterococci infections which present
severe treatment problems particularly in immuno-compromised
patients because these bacteria have become resistant to all
available antimicrobials.
"In the last few years, evidence of the range of public health risks
associated with the use of antimicrobials has grown stronger. With
the adoption of these principles, we have now taken a major step to
reduce these risks on a global scale," stated Dr David Heymann,
Executive Director of the Communicable Diseases Cluster at
WHO.
On 12 June WHO issued a major new report on the usage of
antimicrobials in treating all types of infectious disease (see WHO
press release number 2000/41).
Over 70 experts, from human and veterinary medicine, national
licensing authorities, pharmaceutical companies and international
organizations, such as the Food and Agriculture Organization of
the United Nations (FAO), and the World Animal Health
Organization (OIE), convened at WHO headquarters for the five-day
meeting from 5 to 9 June. They discussed six important areas of
intervention: antimicrobial registration, distribution/sales,
advertising, surveillance, education/training and prudent use.
"We are very encouraged with the presence of other international
organizations, professional societies and the pharmaceutical
industry in this process. It will require the concerted efforts of all
stakeholders to translate the WHO Global Principles into national
action," said Dr Klaus St�hr, Senior Scientist on WHO's Animal
and Food Related Public Health Team and Secretary of the
consultation.
WHO convened meetings of experts in 1997 and 1998 to identify
and assess risks associated with the use of antimicrobials in food
animals. These meetings recognized the existence of the risk for
public health and encouraged WHO to develop principles for
prudent use of antimicrobials in food animals. This is one part of
WHO's Global Strategy for the Containment of Antimicrobial
Resistance.
Full details of the WHO Global Principles can be requested by e-
mailing aph@who.int. For more information, please contact
Melinda Henry, Spokesperson's Office, WHO, Geneva, Telephone
+41 22 791 25 35; Fax +41 22 791 48 58, E-mail henrym@who.int.
All WHO Press Releases and Fact Sheets can be found on
Internet on the WHO home page: http://www.who.int
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Press Release WHO/41 12 June 2000
DRUG RESISTANCE THREATENS TO REVERSE MEDICAL
PROGRESS
Curable diseases from sore throats and ear infections to TB and
malaria -- are in danger of becoming incurable.
New report warns that increasing drug resistance could rob the
world of its opportunity to cure illnesses and stop epidemics
WHO calls for "Wiser and Wider" effort against infectious diseases
Increasing levels of drug resistance are threatening to erode the
medical advances of recent decades, according to a report
released today by the World Health Organization (WHO).
"We currently have effective medicines to cure almost every major
infectious disease," said Dr Gro Harlem Brundtland, Director-
General of WHO. "But we risk losing these valuable drugs and
our opportunity to eventually control many infectious diseases -
because of increasing antimicrobial resistance."
WHO sounded this alarm with the release of its annual Report on
Infectious Diseases, titled "Overcoming Antimicrobial Resistance."
The report is the first of its kind to present a comprehensive picture
of the perilous situation the world is facing as once-effective
medicines become increasingly ineffective.
The report describes how almost all major infectious diseases are
slowly but surely becoming resistant to existing medicines. In
Estonia, Latvia, and parts of Russia and China, over 10% of
tuberculosis (TB) patients have strains resistant to the two most
powerful TB medicines. Because of resistance, Thailand has
completely lost the means of using three of the most common anti-
malaria drugs. Approximately 30% of patients taking lamivudine a
drug recently developed to treat hepatitis B show resistance to
therapy after the first year of treatment. In India, 60% of all cases of
the tropical disease visceral leishmaniasis no longer respond to
first-line drugs. A small but growing number of patients are already
showing primary resistance to AZT and other new therapies for HIV-
infected persons.
In many instances, poorly planned or haphazard use of medicines
has caused the world to lose these drugs as quickly as scientists
have discovered them.
"It took 20 years to develop penicillin for medical use, and then 20
years for this drug to become virtually useless for treating
gonorrhoea in most parts of the world," said Dr David Heymann,
Executive Director of WHO's programme on Communicable
Diseases. In much of South-East Asia, resistance to penicillin has
been reported in 98% of gonorrhoea strains.
A decade ago in New Delhi, India, typhoid could be cured by three
inexpensive drugs. Now, these drugs are largely ineffective in the
battle against this life-threatening disease. Likewise, ten years
ago, a shigella dysentery epidemic could easily be controlled with
cotrimoxazole a drug cheaply available in generic form. Today,
nearly all shigella are non-responsive to the drug.
Those admitted to hospital wards are especially vulnerable. In the
United States alone, some 14,000 people are infected and die each
year as a result of drug-resistant microbes picked up in hospitals.
Around the world, as many as 60% of hospital-acquired infections
are caused by drug-resistant microbes.
Antimicrobial resistance is a naturally occurring biological
phenomenon amplified many-fold due to human misuse and
neglect of antimicrobial drugs. The effect of antimicrobial resistance
is that it can reduce the curative power of once life-saving
medicines to that of a sugar pill.
The social causes fuelling the spread of antimicrobial resistance
are paradoxical. In some settings especially in poorer countries
the under-use of drugs encourages the development of resistance.
For example, where patients are unable to afford the full course of
the medicines to be cured of their illnesses, or can only afford to
purchase counterfeit drugs on the black market, the weakest
microbes in the body may be killed by these insufficient doses
while the more resistant microbes are given opportunity to survive
and multiply.
In wealthy countries, resistance is emerging for the opposite
reason the overuse of drugs. Unnecessary demands for drugs by
patients are often eagerly met by health services prone to over-
prescription. Similarly, overuse of antimicrobials in food production
in wealthy countries is also contributing to increased drug
resistance. Currently, 50% of all antibiotic production is used to
treat sick animals, promote livestock and poultry growth, or rid
cultivated foods of destructive organisms.
Regardless of where drug resistance originates, globalization,
increased travel and trade ensure that these strains quickly travel
elsewhere. With new DNA finger-printing technology, scientists
have been able to identify drug resistant TB strains originating in
Eastern Europe, Asia and Africa and track them as they
increasingly reappear in patients in Western Europe and North
America.
"The world may only have a decade or two to make optimal use of
many of the medicines presently available to stop infectious
diseases," said Dr Heymann. "We are literally in a race against
time to bring levels of infectious disease down worldwide, before
the diseases wear the drugs down first."
The economic consequences of antimicrobial resistance can be
staggering. The cost of treating one person with multidrug-resistant
TB is a hundred times greater than the cost of treating non-
resistant cases. New York City needed to spend nearly US$1
billion to control an outbreak of multi-drug resistant TB in the early
1990s; a cost beyond the reach of most of the world's cities.
"If we fail to make full and proper use of medicines discovered in
our lifetime, many of these drugs will slip through our grasp," said
Dr Rosamund Williams, who heads WHO's team working on drug
resistance. "Before long, we may have missed our opportunity to
control the most dangerous infectious diseases. Indeed, if we fail to
make rapid progress during this decade, it may become very
difficult and expensive if not impossible to do so later."
A common misconception is that the pharmaceutical industry is
frequently making new drug discoveries to replace those drugs that
become ineffective in fighting the major infectious diseases. In
reality, while new versions of older drugs continue to be developed,
there is a dearth of new classes of antibacterials. On average,
research and development of anti-infective drugs takes 15 to 20
years, and can cost over $500 million, according to pharmaceutical
companies.
"Currently, there are no new drugs or vaccines ready to quickly
emerge from the research and development pipeline," said Dr
Heymann. "We are making a high-risk gamble with the public's
health if we are betting on the discovery of new medicines and
vaccines, and neglecting our opportunity to make wiser and wider
use of the effective medicines we currently have available."
According to the report, the most effective strategy against
antimicrobial resistance is to get the job done right the first time
to unequivocally destroy microbes thereby defeating resistance
before it starts. The challenge is to get the right treatment to the
patient, each and every time.
"Used wisely and widely, the drugs we have today can be used to
prevent the infections of today and the antimicrobial-resistant
catastrophes of tomorrow," said Dr Brundtland. "However, if the
world fails to mount a more serious effort to fight infectious
diseases, antimicrobial resistance will increasingly threaten to
send the world back to a pre-antibiotic age. Our grandparents lived
during an era without effective antibiotics. We don't want the same
situation for our grandchildren."
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