Drug-resistant superbugs are rising in the UK because of lack of regulation of antibiotics in developing countries, experts have warned. One of the biggest studies of antibiotic use around the world has established that while antibiotic use in Britain has slowed, global consumption jumped by 65 percent, to 34.8 billion daily doses between 2000 and 2015. The analysis, led by the Center for Disease Dynamics, Economics & Policy (CDDEP) in Washington DC, found the rise is being driven by skyrocketing use in low to middle-income countries such as India, China and Turkey where consumption was up by 114 percent. Resistant infections already kill an estimated 5,000 people in Britain each year. And global deaths are projected to grow to 10m a year by 2030 – one every three seconds – unless urgent action is taken, say experts. The report’s authors say that economic growth is driving the trend in the developing world but conclude that the “decline of antibiotic effectiveness represents a major threat to human health.”
The news comes as a Telegraph investigation into the sale of antibiotics in India has found:
- Multinational pharmaceutical companies, including Abbott, Pfizer and GlaxoSmithKline (GSK), have fuelled the crisis by marketing antibiotics in India that were unapproved elsewhere in the world
- Many multinational companies are continuing to pay their sales teams bonuses for volume sales, despite international calls for them to desist from doing so
- Failures in Indian regulation, with antibiotics given macho marketing names, including Fighttox and Megamycin, and made widely available without adequate controls or prescriptions
- Resistant superbugs bugs being brought back to the UK through travel and tourism, leading to hundreds of new cases in UK hospitals
- British patients were suffering from resistant infections, including an 18-year-old college student who died after contracting a chest infection.
The disclosures are likely to fuel fears about how common infections could become untreatable. The latest study was published on Monday in Proceedings of the National Academy of Sciences. The authors of the report called for urgent action to better control antibiotic use around the world. “As with climate change, there may be an unknown tipping point, and this could herald a future without effective antibiotics,” they said. “Even in the absence of tipping points, the decline of antibiotic effectiveness represents a major threat to human health.”
British doctors were at pains to stress that the issue of antibiotic resistance was not just a future problem but one which is already taking many British lives. Bruce Keogh, the former National Medical Director of the NHS and now Chair of Birmingham Women’s and Children’s NHS Foundation Trust said: “I’ve watched patients deteriorate in front of my eyes because the germs are resistant. It’s a terrible thing for the patient and the family and all concerned. “People think of this as a problem of the future, but the reality is it is a problem now, and it’s likely to get a lot worse in years to come.”
A recent study published in the British Journal of Clinical Pharmacology found that nearly two-thirds of the fixed-dose combination (FDC) antibiotics sold in India had no record of regulatory approval. The use of FDCs, which comprise two or more drugs in a fixed ratio, are only rarely approved in developed countries as they can be harmful and are more likely to spread resistance. The study found that 53 FDCs manufactured by multinationals and sold in India between 2007 and 2012 were not approved in India, and only four were approved in the US and UK. The multinationals involved included Abbott, Pfizer and GlaxoSmithKline. Ramanan Laxminarayan, an expert in antibiotic resistance and director of the CDDEP in Washington DC, said multinational pharmaceutical companies had to take responsibility for the products they sold. “If pharmaceutical companies sell antibiotics as FDCs where there is no clinical evidence for them and where there is likely to be antibiotic resistance there is no justification for it. It’s no longer sufficient for companies to say it’s okay because someone wants to buy my drug,” he said. He said pharmaceutical companies had put “tremendous pressure” on the Indian government which is trying to ban the use of FDCs there. “This is where they make their money – antibiotics are the most commonly sold drug around the world,” he said. The Telegraph has established that some of these products are still available for sale in India without a prescription, with some packets costing less than one pound for ten tablets. Last month, reporters were able to buy an FDC called CEFI XL D RF – which is used to treat bacterial infections – at a chemist in Hyderabad, even though it has not been approved by the Indian national medicines regulator. The antibiotic is marketed by the US pharmaceutical giant Abbott and other drugs linked to the firm also appeared on an electronic database used by pharmacists.
Mark Woolhouse, professor of infectious disease epidemiology at the University of Edinburgh, said the rise in the use of antibiotics in developing countries like India presented a global threat as superbugs travel around the world once created. He said: “You cannot restrict the problem to one country. Once resistance is established it will travel.” Abbott said that the products listed in the study were medicines they acquired in 2010 and many were no longer sold in India. They said that “medicines still available in India all have proper approvals in place.” A spokesperson said that “Fixed-dose combination medicines were created to improve patient adherence and they are important options for doctors when considering the best treatment for their patients, but should only be taken when prescribed by a doctor. This is important particularly in antibiotics, where overuse can contribute to antibiotic resistance.” A spokesperson for Pfizer said that they are “committed to helping the healthcare community confront the challenges of antimicrobial resistance” and that “all our current formulations marketed in India have the applicable regulatory licenses and approvals in place.” They also said that they were one of four companies who had “moved to decouple antibiotic sales volumes from sales agents’ bonuses.” Glaxo did not respond to questions.
Antibiotic resistance in Numbers:
Number whose officials have signed up the UN declaration to tackle the threat of high levels of antibiotics
Per year as a result of drug-resistant infections TB, HIV and malaria
5,000 UK deaths
Estimated number of deaths each year in the UK currently caused by antimicrobial resistance
10 million deaths
The UN’s projected estimates by 2050, as a result of drug-resistant infections, if no action is taken
One in four
The proportion of antibiotic prescriptions – 10 million in total – which Nice said were likely to be unnecessary in 2015
The drop in the number of antibiotics prescribed in 2016 in the UK compared to 2015, as a result of raising awareness among doctors and patients, according to Health Minister Jeremy Hunt
The proportion of antibiotics which contain penicillin, by far the most common for humans, compared with 21.7 percent for antibiotics sold for animal use (Public Health England 2015)
Credit: Claire Newell, Callum Adams, and Paul Nuki for The Telegraph, 29 March 2018.