A recent pig-borne disease outbreak in China that has killed dozens of people has highlighted concerns about what medical experts say is Asia's indiscriminate use of antibiotics. The outbreak is sparking fears that Asia could become a breeding ground for antibiotic resistant "super-germs."
The Streptococcus suis bacteria responsible for the pig-borne disease outbreak in China rarely jumps to humans and is usually curable with the early use of antibiotics.
So doctors now are puzzled that the bacteria has killed at least 39 people in China in recent weeks, raising fears that it has become resistant to antibiotics and more virulent.
The outbreak was first detected in July in Sichuan province, but has since spread to other parts of China and infected more than 200 people, including at least 11 in Hong Kong.
Experts say Asia's indiscriminate use of antibiotics over the years complicates efforts to fight infections such as Streptococcus suis. The World Health Organization (WHO) recently said more than 90 percent of some types of bacteria in Asia no longer respond to so-called first-line antibiotics such as penicillin. Those are the drugs doctors usually turn to first when treating patients with bacterial infections.
Dr. Henk Bekedam, the WHO's representative in China, says this presents a serious threat if resistant bacteria spread.
"I think that's the part we are afraid of, the certain moment we have multiple strains of bacteria [that] don't respond to current available drugs," he said.
The WHO has been monitoring antibiotic resistance in Asia since 1991. Earlier this year, the agency said that resistance rates in several Asian countries for most of the world's common bacterial species are among the highest in the world.
Antibiotics are often available in Asia without prescription. Some doctors prescribe them unnecessarily for minor illnesses, and many patients in Asia demand antibiotics for every ailment.
Experts say this is dangerous.
Dr. Budiono Santoso, regional advisor on pharmaceuticals for the WHO in Manila, says the improper use of antibiotics helps bacteria develop resistance faster.
"There is no control of availability of microbial agents, so free availability of microbial agents, where you can buy everywhere in the market without any prescription, without any control, that sort of thing… the more we use antimicrobials the more there is potential for resistance development," said Dr. Santoso.
Before penicillin was discovered in 1928, people frequently died from infections. Penicillin led to more antibiotics, which have saved countless lives. But if the drugs are not taken properly, not all the bacteria die, and the survivors may adapt to the environment.
"Bacteria also [are] living organisms, so they want to survive, so they find ways of surviving," said Margaret Ip, a microbiologist at the Prince of Wales Hospital in Hong Kong. "It will try to find ways to survive and either get hold of ways to metabolize these antibiotics so it doesn't hurt them or by mutating so that they become resistant to certain antibiotics."
Scientists are unable to develop new drugs as fast as microbes mutate. Antibiotics are expensive to create and many pharmaceutical companies prefer to develop more profitable drugs, so they ignore antibiotics.
Dr. Tan Ban Hock, head of the department of infectious diseases at the Singapore General Hospital says that means doctors have fewer tools for fighting infection.
"While the bugs have evolved and are evolving these resistance mechanisms, we on the other hand are not developing new weapons, thus we are limiting ourselves," said Dr. Hock.
With no new antibiotics, and increasingly resistant bacteria, patients face longer periods of infection with higher risk of death. They also may be more likely to spread their germs to others.
Experts also are concerned about the use of antibiotics meant for humans in animals, especially livestock.
Earlier this year, the WHO criticized China for misusing antibiotics in animals. Dr. Bekedam says this increases the danger of resistance.
"What's important is also making sure that some of the drugs that are very good for humans that they are not being used in animals. Because if you are going to use it in animals, by the time that they can be helpful for humans, they might not work anymore," added Dr. Bekedam.
Because livestock and humans often live close to each other in Asia, the practice increases the risk of animal diseases spreading to humans.
Experts say that many patients do not understand antibiotics. For instance, they are useless for colds and influenza, which are caused by viruses. Many experts say governments and the medical profession must education consumers about antibiotics, and crack down on their use.
The WHO says many countries in the western Pacific have yet to set up surveillance programs to monitor antibiotic use and any resistance to the drugs. The agency recommended establishing such programs in 2001.
During the World Health Assembly in May, the WHO said the resistance problem needed urgent action and called on all members to strengthen laws on antibiotic availability and increase monitoring efforts to contain the risk.