Have We Reached Peak Antibiotics? Emerging antibiotic resistant “super bugs” are an immediate, global health concern.

All too frequently, my original ideas turn out to be no so original. So it is with the comparison of peak oil and antibiotic resistance which has been previously made in a posting in the “Health Ecologist” blog.[1] Nevertheless, I’ll restate the comparison because the essence of both situations is the same, namely that there is a point in time after which quantities of a substance are destined to diminish. In the case of peak oil, it is the point where the global production of crude oil begins to diminish regardless of the drilling effort. For bacterial resistance to antibiotics, it is the point where bacteria develop resistance faster than new antibiotics are produced. Evidence indicates we may have reached the peak in both circumstances.

Bacterial resistance to antibiotics is especially frustrating because it has been a known phenomenon for almost as long as there have been antibiotics[2] and as such we have had the full understanding of what it is and how to prevent, or at least slow, its development. The PBS Frontline report, “Hunting the Nightmare bacteria”[3] is an excellent starting point for understanding the nature and scope of the problem. If you haven’t watched the PBS video my recommendation is to stop reading this posting and watch it.

The science of antibiotic resistance is unambiguous and plentiful. We know how it develops and we understand the consequences of bacteria that are resistant to virtually all antibiotics. The medical community has long recognized the dire nature of this situation and there have been attempts to incent the pharmaceutical industry to increase their RD on antibiotics. Unfortunately, profits drive big pharma and there’s not as much profit in antibiotics as there is in say, Viagra.

The recently published CDC report, “Antibiotic Resistance Threats in the United States, 2013 report”, identifies the etiology, impact and strategies for addressing the problem of antibiotic resistance. A few takeaways from the report include:

  • “More than two million people are sickened every year with antibiotic-resistant infections, with at least 23,000 dying as a result.”
  • “The total economic cost of antibiotic resistance to the U .S. economy has been difficult to calculate. Estimates vary but have ranged as high as $20 billion in excess direct healthcare costs, with additional costs to society for lost productivity as high as $35 billion a year (2008 dollars).”
  • “Up to 50% of all the antibiotics prescribed for people are not needed or are not optimally effective as prescribed.”
  • “Antibiotics are widely used in food-producing animals, and according to data published by FDA, there are more kilograms of antibiotics sold in the United States for food-producing animals than for people.”

The CDC report also identifies four core actions:

  1. preventing infections and preventing the spread of resistance
  2. tracking resistant bacteria
  3. improving the use of today’s antibiotics
  4. promoting the development of new antibiotics and developing new diagnostic  tests for resistant bacteria

All four core actions are important but perhaps the most challenging will be to change the behavior of the public that ultimately uses antibiotics. The more public awareness is raised the more likely is that the problem will receive the attention and the funding it needs.

The people that control their own medicine cabinets must understand the cause of the problem, its severity and their role in causing it. The concept is not daunting. Imagine that it’s your job to thin out a heard of animals by chasing and capturing them. At first you find it easy to capture some of the slower animals but the faster ones get away and can reproduce. The offspring of the escapees inherit their parents’ speed and over time the herd will collectively becomes faster and faster. Eventually, they’ll all be too fast for you to catch any of them. Of course the metaphor is that the animals are bacteria and you are the antibiotic.

One of the biggest problems in the development of antibiotic resistance is that the people contributing to it don’t understand their central role in the process. I would be surprised if everyone doesn’t know someone who has abused antibiotics. For an antibiotics to be effective, they must be taken for the prescribed amount of time – not until you start feeling better. They must be given the chance to kill the whole herd and not just the weakest. And yet, people continue to take their antibiotic for a few days instead of the entire period for which they were prescribed. Even worse are the people who save their left over antibiotics and take one or two when they start to feel sick.

The sheer madness of that thought process is maddening. It would be one thing if one person’s abuse only affected them but the reality is that their resistant bugs will eventually enter the general population as super bugs. These are the people that must be reached if we are to successfully address the problem but these are also the people that are unlikely to read material such as the CDC report. Instead they will get the message through less formal channels and the more voices conveying the message the better.

I’ve come to believe that anything significant that happens in society is the result of small forces acting on the same issue. Much like Brownian motion, the forces may be small and not coordinated but at some point movement occurs. Hopefully, there will be enough time for the random motion to be turned into productive action.

 Additional Reading

World Health Organization Drug Resistance Site

http://www.who.int/drugresistance/en/

Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study – The Lancet

http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(10)70143-2/fulltext

New CDC Vital Signs: Lethal, Drug-resistant Bacteria Spreading in U.S. Healthcare Facilities

http://www.cdc.gov/media/dpk/2013/dpk-vs-hai.html

U.S. Outpatient Antibiotic Prescribing, 2010 – New England Journal of Medicine

http://www.nejm.org/doi/full/10.1056/NEJMc1212055

Antimicrobial Resistance – Infectious Diseases Society of America

http://www.idsociety.org/Topic_Antimicrobial_Resistance/

S. 1256: Preventing Antibiotic Resistance Act of 2013

https://www.govtrack.us/congress/bills/113/s1256

http://www.pewhealth.org/other-resource/bipartisan-senate-bill-introduced-to-combat-superbugs-85899483165

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