A World without Antibiotics?

When Scottish scientist Alexander Fleming came into his laboratory on the morning of September 28, 1928, and noticed that mold growing in a forgotten petri dish was repelling a culture of staphylococcus bacteria, it was the beginning of a new era of antibiotics. Within a decade, the drug he’d named penicillin was being used to cure eye infections in infants, and by World War II, it was saving lives on a massive scale.

But with bacteria developing resistance to antibiotics at a faster and faster rate, and a shortage of new drugs in development, we’re now facing a “post-antibiotic era,” warns Tom Frieden, director of the Centers for Disease Control and Prevention. What does that mean? Common infections that, a generation ago, could be cured with a short course of medication will once again become untreatable and potentially fatal. And with antibiotics playing a critical role in many medical procedures, losing them as a resource could jeopardize our ability to save lives with treatments such as chemotherapy and organ transplants.

“We are going to reach a point where resistance develops to every antibiotic we have,” says Amanda Jezek of the Infectious Diseases Society of America.

Drug resistance is a natural process—the more often bacteria are exposed to an antibiotic, the faster they evolve to protect themselves against it. Misusing antibiotics speeds up that process. In a comprehensive report on the issue released in September, the CDC estimates that as many as 50 percent of the antibiotics prescribed by doctors are not the most effective treatment or are simply unnecessary. Patients can help by not insisting on antibiotic treatment when their doctor says they don’t need it, Jezek notes.

The CDC report also raises concern about the mass use of antibiotics in livestock to promote growth; by some estimates, more antibiotics are now used in food production than medical settings. Not only does this overuse speed up the rate of resistance, it has also been linked to outbreaks of virulent, drug-resistant, foodborne pathogens like E. coli and salmonella sickening consumers.

Also of critical concern is the lack of new medications under development, Jezek says. That’s largely because antibiotics—used for only a few days to cure an infection—are simply less profitable for pharmaceutical companies than drugs that treat chronic conditions.

Recent government actions—including a law passed by Congress two years ago to extend patent protection for new antibiotics, making the drugs a bit more profitable, and a first-of-its-kind federal grant to GlaxoSmithKline to partner on the development of new infection fighters—are encouraging, but “in no way a silver bullet,” she says.

Her group, the professional association for physicians and others who specialize in infectious diseases, is recommending a more streamlined regulatory review for new antibiotics—allowing them to be tested and approved for limited use before hitting the mass market—as well as federal tax incentives to defray research and development costs.

“We don’t want to wait until these infections hit epidemic proportions before we start developing new drugs,” she says.

For some, the post-antibiotic era is already here. The CDC estimates that drug-resistant infections now sicken some 2 million Americans every year, killing 23,000.

But the agency says it is not too late to change course. It recommends four actions: preventing infections before they start (through simple steps like hand washing and sanitation); better tracking of drug-resistant infections; reducing the misuse of antibiotics; and promoting the production of new drugs.

“Antibiotics really are a precious national resource,” said Frieden at a September press briefing. “We need to preserve them for people in the future.”

What You Can Do

If You Have a Minute…
Email your congressional representatives and urge them to support policies that would combat antimicrobial resistance and provide incentives for the development of new antibiotics. “It’s critical that members of Congress get that message from their constituents,” Jezek says.

If You Have an Hour…
If you or someone you know has been affected by a drug-resistant infection, share your experience with the Infectious Diseases Society of America (email [email protected]). “These stories are powerful tools that we use when talking with lawmakers about the human impact of antibiotic-resistant infections,” Jezek says.

If You Have a Month…
Volunteer on the board of your local hospital or nursing home (health-care facilities are where the most virulent “superbugs” spread the fastest), and advocate for the establishment of an antibiotic stewardship program—policies for making responsible antibiotic use consistent from doctor to doctor.

If You Have $100…
Donate to the Food Animal Concerns Trust, a Chicago-based nonprofit that promotes farm animal welfare and advocates for a ban on the unnecessary use of antibiotics in livestock through the Keep Antibiotics Working coalition. Learn more at foodanimalconcerns.org.