In the middle of what should have been the dry season, the skies opened up and pelted Uganda with rain. Towns and fields flooded,
mud-walled homes crumbled, food and other necessities ran out, and the area's already high rates of malaria, diarrheal diseases,
and acute respiratory infections spiked.
Days later, nurse Jacky Tumusiime traveled to a remote village near the Tanzanian border to tend to the sick. When she arrived
at 11:00 a.m., 100 people were lined up waiting for her; some had been there since the night before. Poverty is a good predictor
of disease, and this was a poor town—infectious diseases run rampant here. After a full day, Tumusiime looked up to discover
that the line of patients was longer than when she first arrived.
Cubist Pharmaceutical's Barry Eisenstein, MD, says that specialty companies are missing the "international machinery" and
are not geared to be able to distribute antibiotics to the developing world.
Tumusiime brings supplies that are mostly donated by the good-hearted from her native New Zealand. There are never enough
to go around. Still, during the floods, she's better stocked than the local clinics, which quickly run out of supplies. Of
course, most people buy their drugs on the street and in local shops, not clinics. And mostly, they buy antibiotics.
"These doctors dish out antibiotics like sweets," says Tumusiime. "In fact, it's rare to leave a doctor's office without at
least two types of antibiotics. They are prescribed for everything from broken bones to a lump on the head from falling off
a bike." Many patients, she says, skip doctors' visits and just get antibiotics. After all, it's all they've ever known.
The pattern Tumusiime describes—massive overprescribing and misprescribing of antibiotics—is duplicated throughout the world.
Globally, says Anibal Sosa, MD, director of international programs for the Alliance for the Prudent Use of Antibiotics (APUA),
studies show that between 40 and 90 percent of antibiotic prescriptions are unnecessary.
Misuse of antibiotics, of course, has a cost: antimicrobial resistance (AMR), which in recent years has become an increasingly
worrisome problem the world over. In the last year alone, the news media have reported on two frightening situations in the
United States, an outbreak of methicillin-resistant Staphylococcus aureus (MRSA) and a suspected case of extensively drug-resistant tuberculosis (XDR-TB). But those reports are just the tip of the
iceberg. In 2005 (year of the most recent available data), 94,000 patients were infected with serious MRSA infections and
almost 19,000 people died—more than from AIDS. But it's not only the human cost that's staggering: Some experts suggest that
resistant pathogens in the hospital cost the country nearly $6.7 billion. Other estimates put the cost of hospital-acquired
infections in the developed world—largely due to resistance—at $32.5 billion, more than current global sales of antibiotics.