Perspectives in Health Magazine
The Magazine of the Pan American Health Organization
Volume 7, Number 1, 2002

Increasing costs

The growth of antibiotic resistance means higher healthcare costs. As less expensive, older-generation antibiotics lose their potency, hospitals and physicians must increasingly resort to newer, more expensive drugs.   (Photo ©Armando Waak/PAHO)

Growing antibiotic resistance is also pushing up the costs of treatment, as doctors must increasingly rely on latest-generation antibiotics, often in combination, rather than older, less expensive drugs. In Brazilian hospitals, for example, strains of Pseudomonas bacteria, which typically affect patients with weakened immune systems, were registering 25 percent to 30 percent resistance. Physicians had to resort to a relatively new wide-spectrum class of antibiotics called carbapenems, which also happen to be more expensive.

A study by Mexico's Spanish Hospital showed a major increase in the use of third-generation antibiotics from 1992 to 1997. Of the hospital's own $1.5 million total annual antibiotics bill, $350,000 was found to be inappropriately prescribed. The study concluded that correct control policies and prescribing practices could reduce hospital costs by some $500,000 a year.

A study by Chile's chapter of APUA found that antibiotic sales in their country rose more than threefold from 1988 to 1997, to some $46 million. The study attributed the inordinate rise to the lack of adequate control policies. In Brazil, imports of latest-generation antibiotics such as imipenem, cephalosporins, and polymyxins have been rising in the past three years, according to statistics from Brazil's Ministry of Development. Such rising costs are particularly difficult to manage for the cash-strapped countries of Latin America and the Caribbean.

As a result of this growing international problem, the World Health Organization in 1998 advised its member states to develop controls on antibiotic use. In June 1999, the Pan American Health Organization issued guidelines for its own member countries that included the following measures: the creation of surveillance systems; control of antibiotic sales; better training for health personnel on drug dispensing; control of quality of medicines, including generics; and public education campaigns. It also recommended controls on antibiotic use in animal feed, a practice found in countries such as Argentina, Brazil, and Mexico, as well as the United States and Canada, and which research has shown contributes to antibiotic resistance.

What you can do Consumers play a major role in the growth of antibiotic resistance. But they can also do their part to combat the problem by following some basic guidelines: Do not "demand" antibiotics from your physician. Antibiotics are useful only against bacterial infections. The common cold and flu are caused by viruses, and antibiotics are ineffective in treating these. If your doctor prescribes antibiotics, ask him or her questions about why they are indicated. Also ask about possible side effects and allergic reactions. When you do get antibiotics, be sure to take the full course of medication. Incompletely treated infections are prime culprits in the growth of antibiotic resistance. Never take "leftover" antibiotics to treat an illness; they may be the wrong type, and there will not be enough for a complete treatment, thus contributing to antibiotic resistance. Wash your hands frequently with regular (not antibacterial) soap and warm water. This is the best way to avoid spreading harmful microbes. Keep your hands and fingers out of your mouth, nose, and eyes, the primary portals through which bacteria enter your body.

To date, 12 Latin American and Caribbean countries have taken concrete steps to curtail the growth of antibiotic resistance, mainly through the creation of surveillance systems. But the Region has a long way to go. In Brazil, for example, Ministry of Health officials do not have an exact count of how many hospitals in their country have functioning microbiology laboratories. They do estimate that only half of Brazilian hospitals have infection control centers.

One bright spot in the Region is the growing number of hospital-based programs, aimed at reducing the use of antibiotics and promoting antiseptic conditions that inhibit the development of antibiotic resistance. Since 1997, PAHO has been working closely with Bolivia, Ecuador, El Salvador, Guatemala, Honduras, Nicaragua, and Peru to implement programs for training microbiologists and physicians to tackle the problem.

So far, only Chile and Cuba have implemented truly nationwide programs to curb antibiotic resistance. Beginning in 1999, Chilean public health authorities began enforcing local drug-dispensing laws, complementing their efforts with a public information campaign. The program succeeded in cutting consumption of antibiotics by 22 percent in dollar terms. Cuba's unified health system has effective surveillance and control of antibiotic dispensing, but even there, according to APUA, resistance to antibiotics has been rising.

Other countries are starting to take positive steps. In Venezuela, the government is currently discussing methods to enforce existing controls on antibiotics sales, while Peru is obtaining assistance from USAID to do the same. For its part, Brazil last year named a 10-person multidisciplinary task force in the Ministry of Health to develop a set of guidelines for action; their report is expected later this year.

Antibiotic resistance is probably here to stay, experts say. But "what we have to do now is to make sure that resistance doesn't escalate," says Dr. Ronald Jones, researcher and collaborator at APUA. Compared with other parts of the world, particularly the developed countries, Latin America and the Caribbean may be getting a late start in this battle. But if the steps taken so far are expanded, and coupled with strict enforcement of controls on antibiotic sales, the goal of at least slowing the growth of antibiotic resistance is still within reach.

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