Maryn McKenna

Journalist and Author

World Health Organization: Antibiotic Resistance Grave Global Problem

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Image: Nathan Reading (CC), Flickr

The World Health Organization has released a significant report marking what I think must be the first attempt to quantify antibiotic resistance globally. It’s a very sobering read — not just for what the data says about the advance of resistance worldwide, but also because of what the organization could not say, because the data doesn’t exist.

The numbers themselves are unsettling. Dr. Keiji Fukuda, the WHO’s assistant director general, told the press: “It’s clear that rates are very high of resistance among bacteria causing many of the most common serious infections – the ones that we see both occurring in the community as well as in hospitals … In all regions of the world, we now see that hospitals are reporting untreatable, or nearly untreatable, infections.”

But the gaps in the numbers are too: There are 194 member countries in the WHO, but only 114 had the data-gathering resources to contribute something to the report, and only 22 were able to send in data on the most important occurrences of resistance in very common bacteria. Thus it’s possible that the report could be an under-estimate, or an over-estimate. But I can’t think of a scenario in which it could be considered substantially inaccurate. Its portrait of a world in which antibiotic resistance is advancing to grave proportions ought to be taken seriously.

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Almost-Untreatable Gonorrhea: Proof That It's Here

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If you’ve been following this blog for a while, you might have noticed a thread on health authorities’ growing concern over gonorrhea not responding to the drugs used against it. (And if you didn’t notice you can find those posts here.) A paper published Wednesday evening shows that worry has not been misplaced.

The concern is this: Treatment of STDs in infected people, and programs that aim to keep STDs from spreading from those people to others, rely on drugs that are inexpensive to buy, simple to administer, and work after a single dose and clinic visit. Since the late 1990s, there have been only two drugs that fulfill those criteria: an oral drug called cefixime and an injectable called ceftriaxone (both belonging to the same broader drug family called third-generation cephalosporins). Since the early 2000s, there have simultaneously been signs that resistance to cefixime has been spreading from the Pacific Rim — Japan and Hawaii — to North America, Europe and the rest of the world.

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Resistant Gonorrhea: CDC Says Just One Drug Left

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Well, that didn’t take long.

Exactly 6 months after warning, in a major medical journal, that gonorrhea was becoming untreatable by the last two drugs commonly used against it, the Centers for Disease Control has taken one of those drugs off the table, leaving just one antibiotic available to treat the disease.

In a bulletin published today, the public health agency says that data from the national Gonococcal Isolate Surveillance Project shows a high enough percentage of resistance to the oral cephalosporin cefixime that “CDC no longer recommends cefixime at any dose as a first-line regimen for treatment of gonococcal infections.” Instead, it says, physicians should administer a single dose of injectable ceftriaxone, accompanied by some additional oral drugs.

This has been coming for a while, but it is still unnerving news. It means that the entire structure of sexually transmitted disease control in the United States — single doses of drugs given in single outpatient-clinic visits — now hangs on this one remaining drug. If ceftriaxone also becomes ineffective, then STD treatment will instead become a matter of giving drugs by IV: slower, more complicated, more expensive, and likely more difficult to access.

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Drug-Resistant Gonorrhea: Not Just A U.S. Problem

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If you’ve been reading along, you might remember that in the past year, there has been increasing alarm in the public health community about rising rates of drug-resistant gonorrhea, an almost-beaten sexually transmitted disease that has steadily become resistant to just about all the drugs that can be used against it in the outpatient clinics on which STD control relies. (If you haven’t been reading along, then first, Welcome, and second, here are one two three four posts about the problem.)

Highly resistant gonorrhea — which is to say, gonorrhea that has already become resistant to sulfa drugs, penicillin, tetracycline, and fluoroquinolones such as Cipro, and that is gaining resistance to cephalosporins — first emerged in Japan and over the past decade was carried to the western United States, and then crossed the country. But a recent issue of EuroSurveillance, the journal of the European Centre for Disease Prevention and Control, warns that cases are now increasing in Europe, and exhibiting resistance against the last drug that both worked and was uncomplicated to use.

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Drug-Resistant Gonorrhea: WHO Agrees It's An Emergency

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Image: KaptainKobold/Flickr

The World Health Organization has weighed in on the growing threat from antibiotic-resistant gonorrhea, saying in a statement this morning (emailed, and apparently not online):

Millions of people with gonorrhoea may be at risk of running out of treatment options unless urgent action is taken, according to the World Health Organization (WHO). Already several countries, including Australia, France, Japan, Norway, Sweden and the United Kingdom are reporting cases of resistance to cephalosporin antibiotics — the last treatment option against gonorrhoea. Every year an estimated 106 million people are infected.

The statement arrived as an adjunct to the launch of the WHO’s new global action plan for controlling the spread of resistant gonorrhea.

If you’ve been reading here for a while, the problem of resistant gonorrhea won’t be new to you. (Here are some past posts on data from the CDC and a call to action in the New England Journal of Medicine, along with a piece I wrote in Scientific American and a separate post by my SciAm editor Christine Gorman.) But in case you’ve just come in:

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Drug-Resistant Gonorrhea: How We Lost Track

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if I were starting this blog today, I’d be tempted to name it the Department of Unintended Consequences. So much of what I write about seems to belong in that zone: Send U.N. troops to Haiti, start a cholera epidemic. Aim to eradicate wild polio, clear the way for the vaccine-derived kind. Drive down the price of producing animal protein, ramp up antibiotic resistance.

Now add to the list: Develop cheap rapid tests for detecting sexually transmitted diseases, and lose the ability to track that those diseases are becoming resistant to the last antibiotics that work reliably against them.

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Goodbye, Magic Bullet: Hello, Highly Resistant Gonorrhea

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One hundred years and some months ago — on March 16, 1911 — a publication called the Boston Medical and Surgical Journal printed a description of the treatment of 20 men at Walter Reed General Hospital in Washington, D.C. The men were members of the U.S. Army. Because medical privacy rules were a lot looser 100 years ago, we know most of their names, because the journal gave them: Cornwell, 22 years old; Smith, 24; Randall, 29; Simerly, 27; Brown, 23; Davis, 26; Waits, 22; Allen, 19; Kimmitt, 27; Megee, 29; Laird, 40; Brinson, 34; Franklin, 29; Clements, 34; Johnson, 24; Lorah, 23; and Crabbe, 27.

The men were in Walter Reed, which we now know as Walter Reed Medical Center, because they all had the sexually transmitted disease syphilis. A century later, it seems absurd to be hospitalized for an STD — but in the years before antibiotics, syphilis and gonorrhea were fantastically destructive of productivity. The men’s records, excerpted by the journal, capture that: They had arthritis, ulcerated skin, heart-valve failure, necrosis of the skull. Cornwell had been “on sick report” — unable to report to duty — for 4 months and 10 days; Simerly, for 5 months and 23 days; Kimmitt, for 11 months; Johnson, for 1 year.

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The Clap Came Back: Multidrug-Resistant Gonorrhea

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Among the many unintended consequences of the 30-year AIDS epidemic has been a profound change in status for other sexually transmitted diseases. It feels slightly bizarre, for anyone who came of age after HIV arrived, to realize that syphilis and gonorrhea and their ilk were once as profoundly dreaded as AIDS is now, so important that they were considered major threats to military campaigns and were the first treatment targets for the earliest antimicrobial drugs.

Judging by data released Friday by the Centers for Disease Control, it might be time to take them seriously once again.

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