Commonplace hospital and dental operations could become too risky medically because of the rapid march of superbugs resistant to antibiotics, according to the World Health Organisation.
It warned of the "almost unimaginable repercussions" of a failure to curb the misuse of drugs, which threatened procedures such as hip replacements and cyst removals because infection controls were proving so inadequate.
The WHO report points to the danger that increasing drug resistance among infectious bacteria posed to programmes to reduce the victims of diseases, such as pneumonia, TB, malaria and AIDS. It calls on governments and drug companies to devise new ways of curbing drug overuse in industrialised countries and of encouraging "wider but wiser" prescriptions in developing countries.
The report's publication coincided with the British government's announcement of a new action plan for Britain. This takes in new checks on hospital procedures to prevent cross-infection; fresh guidelines on drugs, dosage and duration of treatments to stop routine overuse of medicines; public education programmes to reduce patients' demands for antibiotic;, and monitoring of use of antibiotics in humans, pets and livestock.
In UK hospitals, resistance to penicillin treatments for the staphylococcus infection - potentially disastrous among patients whose immune systems are already compromised - now occurs among about one-third of cases. Resistance to an alternative antibiotic, methicillin, is nearing similar levels.
The WHO report warned that a small but growing number of patients was already developing resistance to the anti-HIV drug AZT, and that penicillin had become "virtually useless" for treating the venereal disease gonorrhoea. Further, strains of TB resistant to a whole range of drugs, which had emerged in eastern Europe, Asia and Africa, were now reappearing in patients in western Europe and North America. Resistance to the old first treatment of choice for malaria, chloroquine, was widespread in most countries where the disease was still a major killer.
In the US alone, some 14,000 people were infected and died each year from drug-resistant microbes being picked up in hospitals. But some problems in the developing world were caused by underuse, not overuse, with many governments being unable to afford programmes which allowed patients to follow complete courses of antibiotics.
The WHO report criticised the way some drug companies rewarded poorly paid health workers in developing countries with commissions that effectively encouraged them to avoid treatments aimed at specific complaints in favour of broad-spectrum antibiotics. The WHO is in talks with drug companies and governments over the introduction of incentives to develop a new generation of drugs, including tax breaks, extension of patents, and fast-track approvals for some new treatments.