Certain bacterial infections now defy all antibiotics. The resistance problem may be reversible, but only if society begins to consider how the drugs affect good bacteria as well as bad. According to the World Health Organization (WHO), antibiotic resistance is among the major global threats to global health, food security, and development. This in turn, leads to higher medical costs, prolonged hospital stays, and increased mortality. With growing number of infections such as pneumonia, tuberculosis, gonorrhoea, and salmonellosis, the drug resistance significantly affects the treatment of infections. Asia-Pacific has observed a trend of increasing antibiotic consumption in countries, such as China and India, having a diversified patient population where there is a continuous rise in demand for generic antibiotics.
The global demand for antibiotics has grown significantly in the past two decades. There is a range of global pharmaceutical companies, as well as smaller firms in countries, such as India that plays a major role in domestic regions in the production of generic drugs. Most of the antibiotic drugs are cheap, off-patent generic medicines which are easily and widely affordable, especially among the low-income and lower middle-income countries. In addition, the generic industries play a major role in the cost reduction of pharmaceutical drugs, which increase the overall higher availability and consumption, worldwide. As per WebMD, almost 80 percent of the prescription drugs that are sold are generic.
Overall sales in the current antibiotics and new products market were nearly USD 40 billion in 2008. It increased to USD 41.5 billion in 2009. By 2015, it increased to USD 65.5 billion, for a 5-year compound annual growth rate (CAGR) of 9.6 percent. Antibiotic medicines are among the most prescribed courses worldwide in fighting bacterial infections, primarily in outpatient settings.
Antibiotics are critical to the success of surgical procedures including orthopedic prosthetic surgeries, and antibiotic resistance occurs in nearly all bacteria that infect people, including the most common bacteria that cause orthopedic infections, such as Staphylococcus aureus (S. aureus). Most clinical cases of orthopedic surgeries have shown that patients infected with antibiotic resistant bacteria, such as methicillin resistant S. aureus (MRSA), are associated with increased morbidity and mortality. Before the use of antibiotics, the fatality rate for S. aureus bacteremia was high and most wound infections were treated by amputation; for instance, ~70 percent of amputations in World War I were results of wound infections.
The introduction of antibiotics has dramatically improved the fate of infected patients and has changed the way various diseases and surgical procedures are treated. Unfortunately, the discovery and increasingly widespread use (especially the misuse) of antibiotics have led to the rapid appearance of antibiotic resistant strains today; more and more infections are caused by microorganisms that fail to respond to conventional treatments. Antibiotic resistance has a direct effect on treating infections. Patients with infections caused by MDR microorganisms are generally at increased risk of worse clinical outcomes and death, and consume more healthcare resources compared with similar infections caused by antibiotic susceptible strains. Rates of infection with MDR organisms are increasing among immune-compromised persons, as greater numbers of MDRO are observed throughout the population.
Antibiotic prophylaxis and empiric antibiotic therapy influence the selection of these MDRO; susceptibility patterns vary among regions and even within hospitals. The astute clinician is aware of his or her regional unique antibiogram. MDRO, especially gram-negative pathogens, can be associated with worse outcomes among immune-compromised persons, and empiric antibiotic choices must be selected with the local antibiogram in mind if appropriate life-saving antibiotics are to be administered in a timely fashion. The role of rapid diagnostics and newer agents for MDRO is addressed elsewhere; studies are needed among immune-compromised persons to evaluate these novel approaches to improve outcomes.