WHO plan seeks to stanch global antimicrobial resistance

International effort reaches out to physicians, health care workers, pharmacists and even governments in order to control the emergence of super bugs.

By Stephanie Stapleton, amednews staff. Oct. 1, 2001.

Washington -- Warning that antimicrobial resistance is becoming a public health crisis that could undermine the medical advances of the last 50 years, the World Health Organization last month unveiled a global strategy to combat and contain it.

The plan's urgency is based on a clear message: While physicians in most places in the world can now reach into the medicine chest and find an effective antibiotic to treat their patients, these tools could be rendered useless if actions to curb selective pressure are not taken.

Containing the super bugs' spread
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Over the past three years, WHO has worked to build a framework of interventions designed to slow the emergence and reduce the spread of resistant microorganisms.

"What sets this initiative apart is that it is put together by the world's leading public health group," said Stuart Levy, MD, professor of medicine and microbiology at Tufts University School of Medicine, Boston and the president of the Alliance for the Prudent Use of Antibiotics. It is a "true how-to" in terms of containing and understanding the antibiotic resistance issue, he added.

It involves lessening the disease burden and the spread of infection; improving access to and use of appropriate antimicrobials; and strengthening health systems and public health surveillance capabilities worldwide.

Overall, a central part of the plan involves physicians, providing them with the education and evidence necessary to advance correct prescribing practices and to deal with patient expectations.

"This strategy is designed to promote the wiser use of drugs so that resistance is minimized and effective treatments can continue to be used for generations to come," said David Heymann, MD, WHO executive director for communicable diseases.

The AMA praised the plan.

"One of the most promising aspects of the WHO's strategy is that it focuses on physicians, pharmacists and the public, all of whom have ultimate responsibility for preserving the effectiveness of antimicrobials," said AMA Trustee Ronald M. Davis, MD.

A true how-to

The global muscle of resistant microorganisms is increasingly evident. It is difficult to collect the data regarding the human and economic costs of these infections. However, in several countries tuberculosis strains have become resistant to at least two of the most effective drugs used against the disease, and commonly used antimalarial drugs have become virtually useless because the parasite has acquired resistance, according to WHO.

Rosamund Williams, PhD, coordinator of WHO drug resistance activities, explained that in preparing the current strategy, WHO reviewed existing worldwide literature. "We have a better feel for the problems," she said, and a better concept of what might work in terms of solutions.

Though the strategy's actual marching orders are vague, they will allow individual countries to adapt the various recommendations to their very specific problems and situations, according to AMA staff.

Finding this balance was part of the challenge in developing guideposts useful for developed and developing nations, explained Dr. Williams. "What needs to be done is essentially the same all over the world. But different countries are in different stages," she said. "The strategy can be taken and applied in any country regardless of its particular disease problems or level of health care system."

It is also inclusive, Dr. Williams said. "It attempts to show how complex and interrelated the many facets of the drug resistance problems are and to draw out the threads so that each group of people involved can recognize and appreciate the role they have to play," she said.

If the strategy is successful, the change will be evident in the doctor's office. Better informed patients would be less likely to pressure their doctors to give them antibiotics. Better-prepared doctors would be more likely to follow the most up-to-date treatment guidelines and prescribe only the drugs that are required for treatment, rather than reaching for the newest or best-known medicines.

Dr. Levy said that doctors have already shown changes in prescribing patterns. "I think doctors are doing better -- in some part because consumers have been put on notice as well," he said.

But there are a large number of reasons why physicians and patients continue on their current path.

"Many things influence the behavior of a prescriber," said Dr. Williams. It is quite rare that physicians prescribe antibiotics and a patient comes back with a resistant infection, she said. Drug resistance is something out there -- not something in front of physicians when they are treating their patients, not part of this one-on-one contact, she added. That makes the behavior hard to change, she said.

ADDITIONAL INFORMATION:

Containing the super bugs' spread

Highlights of the World Health Organization's global recommendations for physicians, other prescribers and dispensers of antimicrobials:

Educate prescribers and dispensers on the importance of appropriate antimicrobial use, containment of antimicrobial resistance, disease prevention and infection control.
Target professional education programs to the accurate diagnosis and management of common infections.
Promote the education of patients about antimicrobial use and the importance of adhering to prescribed treatments.
Alert prescribers and dispensers to factors that influence prescribing habits, such as economic incentives, promotional activities and pharmaceutical industry inducements.
Improve antimicrobial use by supervision and support of clinical practices, especially diagnostic and treatment strategies.
Encourage use of treatment guidelines to foster appropriate use of antimicrobials.
Link professional registration requirements to training and continuing education.

Source: "WHO Global Strategy for Containment of Antimicrobial Resistance," September