Committee: World Health Organization

Topic B: The increase in anti-biotic resistance

 

Director: Cecilia Guadiana Mandujano

Moderator: María José Reyes Morales

 

Committee Background:

The World Health Organization is the directing and coordinating authority for health within the United Nations system. They have as a responsibility to provide leadership on global health matters, maintain health agenda, setting norms and standards, providing technical support to undeveloped countries as also monitoring and assessing health trends. WHO operates in an increasingly complex and rapidly changing landscape, as it responds using a six-point agenda.

 

The World Health Organization Constitution came into force on 7 April 1948; this organization was created for the only purpose of global health and also as an objective “is the attainment by all peoples of the highest possible level of health”. The World Health Assembly is the supreme decision-making body for WHO. It meets each year on May in Geneva, Switzerland and is attended by delegations from all 192 Member States. The Executive Board is composed of 34 members basically qualified in the field of health. Members are elected for a three-year term. The main Board meeting, for the agreement and resolutions adopted forward for the Health Assembly, is held in January. WHO has as a purpose: “the attainment by all peoples of the highest possible level of health”. Their goal is to combat diseases and promote general health worldwide. Health as a meaning for WHO is defined as being “a state of complete physical, mental, and social well-being and not merely the absence of disease of infirmity. WHO as any other committee on the United Nations cannot force any country to become a part of it, but as a goal health promote is important for human being and can suggest and assure them to make intelligent decisions on health services.

                                                 

Topic Background:

Antibiotic is a substance or compound that kills or inhibits the growth of bacteria, used to treat infections caused by microorganisms, including fungi and protozoa. This original definition excluded naturally occurring substances that kill bacteria but are not produced by microorganisms most antibiotics are now semi synthetic modified chemically from original compounds found in nature, as is the case with beta-lactams that includes penicillin.

The emergence of antibiotic resistance is an evolutionary process that is based on selection for organisms that have changed ability to survive doses of antibiotics that would have previously been lethal, any antibiotic resistance may impose a biological cost and the spread of antibiotic resistance bacteria may be hampered by the reduced fitness associated with the resistance which proves disadvantageous for survival of the bacteria when antibiotic is not present. Additional mutations, however, may recompense for this fitness cost and aids the survival of these bacteria. Antibiotics have been used by many people worldwide, for the purpose for their well-being health; cure any illness, any medication problem or disability. Antibiotic resistance occurs when bacteria in your body change so that antibiotics don't work effectively to fight them anymore. This can happen when bacteria are repeatedly exposed to the same antibiotics or when bacteria are left in your body after you have been taking an antibiotic (such as when someone does not take the full course of their antibiotic medicine). These bacteria can multiply and become strong enough to resist the antibiotic in the future. In some cases, most of the people get ill, and they auto reset antibiotics, every time they take antibiotics when you don't need them or you do not take all of the antibiotics recommended by your doctor, you increase the chance that you will someday get an illness that is caused by resistant bacteria.

When antibiotics don't work, the result can be

· Longer illnesses

· More complicated illnesses

· More doctor visits

· The use of stronger and more expensive drugs

· More deaths caused by bacterial infections

 

 

Countries:

 

United States: Because antibiotics are used a lot, and sometimes are used inappropriately, antibiotic resistance is becoming a common problem in many parts of the United States. Every year in the United States 25 million pounds of valuable antibiotics are roughly used. 70 percent of total US antibiotic production is fed to chickens, pigs, and cows for no therapeutic purposes like growth promotion, according to a new report from the Union of Concerned Scientists. 30 percent of people in immigrant communities in the United States are obtaining antibiotics at local bodegas. Antibiotics have long been used to treat illnesses in humans and farm animals. About 50 years ago, the U.S. Food and Drug Administration (FDA) approved their use in feed in sub therapeutic or low doses to help animals grow faster, produce more meat and avoid illnesses. In cooperation with other government agencies, the Food and Drug Administration (FDA) has launched several initiatives to address antibiotic resistance. The agency has issued drug-labeling regulations, emotive the prudent use of antibiotics. The regulations encourage health care professionals to put aside antibiotics only when clinically necessary, and to save patients about the proper use of such drugs and the importance of taking them as directed. FDA has also encouraged the development of new drugs, vaccines, and improved tests for infectious diseases.

 

France: The prevalence of penicillin-no susceptible pneumococci is sharply divided between France (43%). A French review showed that, during a 3-month period in 1991, 25% of the French population was treated with an antibiotic, compared with 17% in 1980. In particular, the frequency of respiratory area infections with a presumed viral cause that were diagnosed and treated with antibiotics increased by 86% for adults and by 115% for children in the 11-year period.  However, French physicians may overestimate the extent to which patient satisfaction depends only on receiving an antibiotic prescription; therefore patients should be convinced that the primary determinant of patient satisfaction is not prescribing antibiotics but rather, effective communication about the patient’s illness. France has a campaign, which used to be known for the highest rates of antibiotic use and its resistance in Europe. In 2001, French policy makers and public health authorities opened a coordinated and multifaceted strategy for the control of antimicrobial resistance. One of the key interventions was a yearly campaign targeting the public via media, converting the message that “Antibiotics Are Not Automatic” Therefore, the streptococcal rapid antigen test and treatment guidelines were promoted among health care professionals. The decrease was seen in all French regions and age groups, with the highest decrease observed in children.

 

United Kingdom:

New figures released by the Health Protection Agency (UK) show that levels of antibiotic resistance in gonorrhea, the second most common bacterial sexually transmitted infection, continue to increase. Show that levels of resistance have increased from 14% in 2004 to 21.7% in 2005 and resistance to penicillin has increased from 11.4% in 2004 to 17.9% in 2005. The levels of resistance remained relatively stable in women from 5.2% in 2004 to 6.3% in 2005 and heterosexual men from 10.3% in 2004 to 11.8% in 2005. However, the prevalence significantly increased in homosexual men from 26.2% in 2004 to 42.4% in 2005. This increasing resistance to penicillin and ciprofloxacin is concerning the highlights; the need for anyone who is infected needs to be treated with the recommended therapy. To assess the extent of these problems UK reviewed antibiotic vulnerabilities isolated from routine clinical specimens in lookout laboratories throughout the UK.

 

Russia:

Recent review isolated from the penicillin of healthy children attending day-care centers in Moscow showed that 7.5% were intermediate-resistant to penicillin. There were no highly penicillin-resistant strains found, it was active against all penicillin non-susceptible isolates. Macrolide resistance level was 4.6%. The highest rate of resistance was proved to be to trimethoprim/sulfamethoxazole - 56.8%. Vulnerability testing of gonococci requires a special medium, which is quite expensive and not easily available in Russia. It has been also shown that the highest frequency of resistance was observed to ampicillin with 33.3%.

 

China:

If large countries or groups of countries that are likely to jump ahead in their integration with the rest of the world, China being the standout case have high and distinctive patterns of antibiotic resistance, then a coordinated response could considerably help to control the spread of resistance around the country. Primary measures are the prevalence of resistance of specific bacteria to specific antibiotics. China also proposes and illustrates methods for aggregating specific "bug-drug" data. China has the highest level of antibiotic resistance, followed by Kuwait and the U.S. In a study of resistance patterns of several most common bacteria in China in 1999 and 2001, the main prevalence of resistance among hospitals infections was as high as 41%. China also has the most rapid growth rate of resistance with an average of 22%.

 

Mexico:

The strength of the hospital group was 86%, while total consumption of antibiotics in hospital ranged between 44 and 195 Defined Daily Doses/100 day beds. The World Health Organization has recommended a number of strategies based on national drug policies. In Mexico, several aspects about the inappropriate use of antibiotics have been documented. In response they have been developed educational and managerial interventions meant at doctors in public health services and epidemiological surveillance programs. The research and interventions focused on consumers, pharmacies and the private sector are scarce. Fundamentally, there is no national strategy on antibiotics as reflected by the pharmaceutical and health policies in the country.

 

South Africa:

In Soweto, South Africa, 50% of S. pneumonias isolates from HIV-infected children, which are resistant to penicillin, with a range of 23% in HIV-negative children. Gonorrhea remains one of the commonest as global perspective and, left untreated or treated inadequately it may result in serious complications such as epidemics and pelvic inflammatory disease. It has acquired a number of chromosomal and mediated antibiotic resistances. In a rural, impoverished area of South Africa, a scary outbreak is occurring primarily among AIDS patients, a type of tuberculosis that is extremely drug resistant and the majority of people take antibiotics against this, without any medical prescription.

 

Canada:

The Canadian Committee on Antibiotic Resistance was created in 1998 as a coordinating and advocacy group for the support of Canadian efforts to control the development and spread of antimicrobial resistance. It provides a unique and productive intersection of the human health and food sectors. It also worked with various levels of government to develop policy and develop solutions for managing antibiotic resistance. As it declined 11% based on the total number of prescriptions dispensed on antibiotic resistance between 1995 and 2004. There was also a 21% decrease in ß-lactam prescriptions during this same period. And it has been increasing exponentially in the past few years.

 

How You Can Help To Prevent Antibiotic Resistance...

 

-Do not take an antibiotic for a viral infection like a cold, a cough or the flu.

-Antibiotics should be used only to treat bacterial infections.

-Take an antibiotic exactly as your healthcare provider tells you. Do not skip doses.

-Complete the prescribed course of treatment, even if you are feeling better.

-Do not save any antibiotics for the next time you get sick.

-Discard any leftover medication once you have completed your prescribed course of treatment.

-Do not take antibiotics prescribed for someone else,

not even those from friends and family members.

-The antibiotic may not be appropriate for your illness.

-Taking the wrong medicine may delay correct treatment and allow bacteria to multiply.

-Antibiotic prescriptions in outpatient settings can be reduced dramatically

without adversely affecting patient health by not prescribing antibiotics for viral illnesses,

such as colds, most sore throats, coughs, bronchitis, and the flu.

-Do not demand antibiotics when a healthcare provider has determined they are not needed.

-Talk with a healthcare provider about antibiotic resistance.

 

Facts About Antibiotic Resistance:

Antibiotic resistance has been called one of the world’s most pressing public health problems.

The number of bacteria resistant to antibiotics has increased in the last decade. Many bacterial

infections are becoming resistant to the most commonly prescribed antibiotic treatments.

Every time a person takes antibiotics, sensitive bacteria are killed, but resistant germs may be left

to grow and multiply. Repeated and improper uses of antibiotics are primary causes of the

increase in drug-resistant bacteria.

Misuse of antibiotics jeopardizes the usefulness of essential drugs. Decreasing inappropriate

antibiotic use is the best way to control resistance.

Children are of particular concern because they have the highest rates of antibiotic use. They

also have one of the highest rates of infections caused by antibiotic-resistant pathogens.

Parent pressure makes a difference. For pediatric care, a study showed that doctors prescribe

antibiotics 65% of the time if they perceive parents expect them and 12% of the time if they feel

parents do not expect them.

Antibiotic resistance can cause significant danger and suffering for people who have common

infections that once were easily treatable with antibiotics. When antibiotics fail to work, the

consequences are longer-lasting illnesses, more doctor visits or extended hospital stays, and the

need for more expensive and toxic medications. Some resistant infections can even cause death.

 

Why has antibiotic resistance increased in humans?

 

It is widely accepted that the primary cause is overuse and misuse of antibiotics. In some cases, doctors prescribe or patients demand the drugs too frequently or inappropriately, such as for illnesses that are not caused by bacteria and do not respond to antibiotics. In other cases, patients fail to complete the prescribed course of an antibiotic treatment, making it more likely that surviving bacteria will develop resistance to the drug.  There is also evidence that antibiotic use in food-producing animals contributes to human drug resistance, although to a far lesser degree than human use does. The controversy centers over how significant this contribution is, how much of the problem stems from sub therapeutic use and how to respond. 

 

WHO improvements on Antibiotic Resistance

The leading health agencies in the U.S. and European Union (EU) and World Health Organization (WHO) agree that the link is serious enough to ban the sub therapeutic use of at least some antibiotics in farm animals. There is considerable debate over the use of antibiotics to promote growth in farm animals. Among the strongest opponents is the World Health Organization (WHO), which in August 2003 recommended that nations stop using antibiotics for growth promotion. WHO asserts “the largest quantities” of antimicrobials given at low doses to food- producing animals “are used as regular supplements for growth promotion, those exposing a large number of animals, of their health status.

 

Questions for the delegate:

-What is the percentage use of antibiotic resistance in your country?

-Does your delegation already have a campaign, to take care of this problem?

-Why has antibiotic resistance increased in humans?

-What are the functions of an antibiotic?

-What are your solutions to reduce antibiotic resistance?

-Which types of antibiotics are the people in your country suffering from?

-Has WHO made an intervention, helping your country with antibiotic resistance?

 

Bibliography:

http://www.cdc.gov/search.do?action=search&queryText=antibiotic+resistance&image.x=0&image.y=0

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2738507

http://www.cdc.gov/ncidod/eid/vol8no12/pdfs/01-0533.pdf

http://www.bio-medicine.org/medicine-news-1/Antibiotics-Bought-Easily-on-the-Internet-57250-3/