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May 4, 2011

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Superbug Super-problem

RAMPANT use of antibiotics in China by individuals, doctors, hospitals, agriculture and fisheries poses a serious health problem contributing to the emergence of antibiotic-resistant superbugs. Zhang Qian reports.

After her 6-year-old son kept coughing for three days and the medication recommended by the doctor seemed not to help, Susan Lin decided to take matters into her own hands and medicate the boy.

She bought a popular antibiotic (generic cephalosporin/brand Cefradine) from a pharmacy and administered it along with the patent cough medicine.

òThe standard cold medicine is just too mild to work,ó says the 33-year-old mother. òI cannot watch him coughing day and night like that. This antidote works much faster. I have tried it several times myself and I?m sure it works.ó

The boy got better. The broad spectrum antibiotic is used to treat respiratory, genitourinary, gastrointestinal, skin and soft tissue, and bone and joint infections.

Lin is just one of millions of Chinese who abuse antibiotics that are available in pharmacies with a prescription, in some cases, available by just jotting down the client?s name and phone number for record.

She and millions of other people have blind faith in fast-acting antibiotics.

Many patients believe antibiotics are the most useful weapon to fight many problems,ó says Dr Ni Yuxing, professor of medical laboratory sciences and clinical microbiology at Shanghai?s Ruijin Hospital.

òWhen the antibiotics fail to work, they just ask for stronger antibiotics.ó

Chinese health officials and doctors have been warning for a long time that misuse and overuse of antibiotics ? for both humans and animals ? leads to increased resistance to the strongest antibiotics. This potentially makes China vulnerable to an outbreak of drug-resistant superbugs, so hospitals are taking extra precautions with hygiene and other infection-control measures.

What happens in China can have reverberations in a globalized world.

A number of years ago, annual per capita consumption of antibiotics in China was estimated at 138 grams (including medicine and food) ? that?s 10 times the per capita consumption in the United States, according to the statistics by China?s State Food and Drug Administration in 2006. The numbers and the gap are likely higher today.

China already has reported three cases of NDM-1 (two in the Ningxia Hui Autonomous Region, one in Fujian Province) and a number of the more common MRSA, often linked to hospital sepsis and long hospital stays.

NDM-1, a gene that makes bacteria immune to most antibiotics, is New Delhi metallo-beta-lactamase-1, first identified in 2009 in New Delhi, India. Because of air travel, it has spread to many countries. The first reported death was recorded last August with a Belgian man who got infected during a trip in Pakistan.

But so far NDM-1 has only been detected in two bacteria, escherichia coli in the intestines and klebsiella pneumonia that causes pneumonia ? both serous.

Much more common in China and other countries is MRSA, methicillin-resistant Staphylococcus aureus; it?s been around for a long time around the world and is one of the major resistant pathogens. It was one of the earliest bacteria in which penicillin resistance was found in 1947.

There are around 10 superbugs that are resistant to at least three types of antibiotics.

According to the British medical journal The Lancet in 2008, 40 percent of the pathogenic bacteria in China?s hospitals are drug-resistant bacteria. The rate of increase reported at that time was 26 percent, the world?s highest.

A report by China?s Ministry of Health for 2006-2007 showed that the rate of antibiotics use in hospitals around the country was around 74 percent, compared with 22-25 percent in most Western countries. But infectious diseases only accounts for 49 percent of the diseases in China, and bacterial infection only represents 18-21 percent, according research from 1995-2007. Some experts estimate that around 80 percent of the antibiotics used in China are not necessary.

Government guidelines for antibiotic use in 2004 and 2009 have had little impact.


The brand antibiotic that Susan Lin gave to her son, a cephalosporin, is a favorite with many Chinese. It?s a staple in the medicine cabinet of David Chen, a 62-year-old physics teacher who say it seems to cure everything.

He says it provides fast relief for problems like diarrhea, sore throat and inflamed wounds. Whenever he sees a doctor, he always asks for more, and usually gets it. He keeps it in the refrigerator for an emergency.

òTake a pill, get some sleep and you will feel much better in the morning,ó Chen says, adding that he always recommends it to family and friends.

In 2010, researchers from the Chinese Pharmaceutical Association surveyed the medicine cabinets of many Chinese families and found that more than 70 percent keep antibiotics at home and dose themselves when they think it?s necessary.

òIn most cases, antibiotics are not necessary. Virtually all the common colds, with or without fever, are caused by viruses, so antibiotics are useless,ó says Zhang Yanxiang, president of the Hangzhou No. 3 People?s Hospital. òThe best thing is to drink water and get some rest.ó


Numerous antibiotics are used in raising livestock, fish and animals for sale as pets. This prevents certain diseases but also accelerates mutation and resistance of bacteria. The bacteria and superbugs in animals get into the human system through the food chain and close contact between humans and animals.

What are needed are medical breakthroughs with new forms of antibiotics that can kill the superbugs, but little basic research is underway worldwide.

Research and development, clinical trials and getting a new drug approved and on the market costs hundreds of millions of yuan and can take 10 years or more. But it only takes around two years for a bug with tolerance to appear, according to Dr Ni.

And there?s not much profit in antibiotics ? take some pills for five days and you get better ? but there is big money in drugs for chronic conditions, such as heart problems and diabetes.

Thus, there?s not much financial incentive to fight the superbugs, unless governments direct and fund the efforts.

So far, only a few international pharmaceuticals companies are still developing antibiotics, including Pfizer, GlaxoSmithKline, Merck, Novartis and AstraZeneca. Most Chinese pharmaceuticals companies are producers, not developers.


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