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19 ANTIBIOTIC RESISTANCE & STEWARDSHIP Global antibiotic shortages are fueling superbugs: 5 report findings By Mackenzie Bean G lobal antibiotic shortages, caused by a fragile drug supply chain, are contributing to the rise of multi- drug-resistant bacteria known as superbugs, accord- ing to a report from the Access to Medicine Foundation. e report outlines the various causes of antibiotic shortag- es, their consequences and what actions stakeholders must take to remedy the situation. Here are five things to know: 1. Antibiotic shortages are, unfortunately, a common occurrence. e U.S. experienced 148 national antibiotic shortages between 2001 and 2013. Fieen countries re- ported shortages of injectable streptomycin in 2010, which hindered treatment for tuberculosis patients. At present, 39 countries are experiencing a shortage of penicillin. 2. AMF attributes the shortages to an unstable global drug supply chain that relies on only a few suppliers for key drug ingredients. Under such a system, one supplier's manufactur- ing snag can cause serious consequences for drugmakers and patients worldwide. For example, piperacillin-tazobactam, a crucial broad-spectrum antibiotic, has been in short supply globally since a 2016 explosion at a Chinese drug factory. 3. In addition, drug companies have little incentive to create new antibiotics since "[research and development] is risky and expen- sive, antibiotics offer slim margins and growth in demand comes mainly from poorer countries," according to AMF. 4. AMF also believes antibiotic shortages are contributing to the rise of superbugs, as physicians must rely on less effec- tive treatments when key antibiotics are in short supply. "is makes infections harder to cure, and in turn, creates opportunities for bacteria to adapt their defences [sic]," the nonprofit group wrote in the report. 5. AMF shared various strategies some drugmakers are already using to mitigate shortages, such as investing in networks of production facilities to prevent over-reliance on a small pool of suppliers. "e global health community including the pharmaceuti- cal industry has experience in getting medicines to people who need them," said AMF Executive Director Jayasree K. Iyer. "What is critically needed now is to puzzle out how this knowledge can be used to secure antibiotic supply, especially in low- and middle-income countries where the need for antibiotics is simply staggering." n Physicians battle first drug- resistant typhoid outbreak: 8 things to know By Megan Knowles T he first known epidemic of extensively drug-resis- tant typhoid has infected approximately 850 people in Pakistan across 14 districts since 2016 and is anticipated to disseminate globally, according to data from the National Institute of Health Islamabad cited by e New York Times. Here are eight things to know: 1. e typhoid strain, which is resistant to five kinds of antibi- otics, will replace weaker strains where they are endemic. Experts identified azithromycin as the only remaining oral antibiotic to fight this strain. However, one more genetic mutation could make ty- phoid untreatable in certain areas. 2. Researchers are viewing the epidemic as a call to implement comprehensive prevention efforts. If vaccination campaigns and modern sanitation systems fail to outpace the pathogen, researchers expect a return to the pre-anti- biotic era, where mortality rates skyrocketed. "is isn't just about typhoid," said Dr. Rumina Hasan, a pathology professor at the Aga Khan Univer- sity in Pakistan. "Antibiotic resis- tance is a threat to all of modern medicine — and the scary part is, we're out of options." 3. Typhoid fever is a highly infectious disease transmitted by contaminated food or water and caused by the Salmonella Typhi bacteria. Symptoms include high fevers, headaches and vomiting. Around 21 million people suffer from typhoid each year, according to the World Health Organization. 4. e outbreak originated in the city of Hyderabad in India, where early case mapping showed victims clustered around the city's sewage lines. Researchers found water sources in the region that could be contaminated by leaking sewage pipes. Of the four deaths reported so far, at least one travel-related case was detected in the U.K. 5. Genetic sequencing revealed a multidrug resistant typhoid strain called H58 interacted with anoth- er bacteria, likely Escherichia coli, and acquired an additional DNA molecule that coded for resistance to the antibiotic ceriaxone. 6. In the Sindh province of Pakistan, physicians are treating the strain with azithromycin and more expensive treatments required to be administered in hospitals. 7. To preserve the last line of defense against the strain, public health officials launched a cam- paign to vaccinate 250,000 chil- dren in Hyderabad using a new typhoid conjugate vaccine. e vaccine lasts at least five years and children as young as six months old can receive it, according to the WHO. Experts are also reinforc- ing habits such as frequent hand washing, boiling drinking water and eating well-cooked foods. 8. "It's a global concern at this point," said Eric Mintz, MD, an epidemiologist at the CDC. "Every- thing suggests this strain will sur- vive well and spread easily — and acquiring resistance to azithromy- cin is only a matter of time." n