Antibiotic resistance in Canada at the dawn of the new millennium - a model for the developed world?

Antibiotic resistance has increased dramatically and rapidly during the 1990s, and it is widely acknowledged to be a serious threat to the treatment of infectious diseases on a global basis (1-6). The morbidity, mortality and economic burden of infections with multiply drug resistant organisms, for which there are no effective therapies, pose an increasing burden for health care systems worldwide; Canada is no exception (7). Without effective public health strategies, grim warnings of a postantibiotic era may become a reality. In addition to significant increases in costs and greater toxicity of newer drugs, antibiotic-resistant organisms are continuously eroding the therapeutic armamentarium, leaving fewer or no alternative agents available. Although much has been written about antibiotic resistance during the past few years, it is noteworthy and relevant that both the World Health Organization (WHO) (8) and the Centers for Disease Control and Prevention (CDC) (9), have released reports on this topic this past June. The WHO report, entitled Overcoming Antimicrobial Resistance (8), gives a stark warning that, at the dawn of a new millennium, humanity is faced with a crisis, where rising rates of drug resistance in many microorganisms could rob the world of its opportunity to cure many common infectious diseases. The report (8) describes multidrug-resistant (two or more firstline drugs) Mycobacterium tuberculosis rates of over 10% in Estonia, Latvia, and in parts of Russia and China; complete loss of the three most commonly used antimalarial drugs in Thailand due to resistance; lamivudine resistance rates of 30% to hepatitis B virus; cotrimoxazole-resistant Shigella dysenteriae rates of nearly 100% in certain parts of India; and rates of hospital-acquired, methicillin-resistant Staphylococcus aureus (MRSA) of 60% in several industrialized nations. Although the report acknowledges that antibiotic resistance is a natural biological phenomenon, it suggests that it becomes a significant public health burden when it is amplified by human misuse and neglect. Overuse of antibiotics in developed nations and, paradoxically, both misuse and underuse in developing nations have contributed to the burden. Due to fears of resistance, many health care providers are avoiding narrow spectrum drugs in favour of broader spectrum antibiotics that have wider applications and greater impact on the natural flora. The report also indicated that unethical pharmaceutical companies sometimes pay a commission for recommending more expensive broader spectrum medications when cheaper narrow spectrum alternatives would suffice, resulting in a smaller, highly priced pool of antibiotics for a larger spectrum of infectious diseases (8). The WHO report suggests developing a global strategy to contain resistance and to build alliances involving all healthcare providers – countries, governments, international organizations, nongovernmental organizations and both the private and public health care sectors – in an effort to quell the rising tide of resistance. The WHO’s Global Strategy for the Containment of Antimicrobial Resistance offers a series of recommendations aimed at enabling countries to define and implement national policies designed to maintain antimicrobial efficacy. In the United States, a draft version of the document entitled Public Health Action Plan to Combat Antimicrobial Resistance (9) was also made available in June of this year. The Action Plan, which was developed by an interagency task