Antibiotic Stewardship:

Managing antibiotic
resistance

Step 1.13

[MUSIC PLAYING]

[Maryn McKenna] Multidrug resistant TB, extremely drug-resistant TB, and

totally drug- resistant TB are emerging the fastest in places where antibiotic
access is the least controlled.

[Ramanan Laxminirayan] It's the combination of the ability to transfer bugs

around the world with the greater pressures in many parts of the world for
these bacteria to evolve that's going to create much more of a problem in
years to come.

[Dr. John H Rex] The scenarios that scare me the most are the ones that I
think are likely. Explosive outbreak could always occur, but what we're
already seeing are situations in which we have really dangerous organisms
like tuberculosis that are very, very difficult to treat. And we know they are
spreading.

[Dr. Tom M Chiller] I was visiting South Africa on a recent trip, and I went to
the specific hospital where they housed the XDR patients with TB. XDR
stands for Extremely Drug Resistant. And what it essentially means is these
tuberculosis bacteria are resistant to everything. So there is no drug that is
susceptible. And you use all kinds of combinations and different drugs to try
to treat these patients.

And I went to the ward that housed the children with XDR TB. And I think
that seeing these kids in a room-- most of them happily playing, because
they are kids-- knowing that they have this bacteria that is resistant to
everything that we have was a really eye opening experience for me. And I
mean, I think it makes you think about a lot of things. But it certainly makes
you think about these helpless kids who have gotten a resistant bacteria
that essentially was created by our use, and misuse, maybe, of some of
these antibiotics.

[Ramanan Laxminirayan] Now as we see more antibiotic consumption in the

developing world just as people can afford them, that's going to
undoubtedly place much more selection pressure on resistant bacteria to
evolve.

[Dr. Stuart B Levy] And if enough drug is given, and for enough time, these
resistant forms take over that environment, and you change completely the
kinds of bacteria that are living in that farm, that house, that hospital.