Superbugs and the Rise of Antibiotic Resistant Bacteria
The era of modern medicine began with the introduction of antibiotics. It may end with their demise.
Common infections and minor injuries can kill
In a recent report published by the World Health Organization, Dr. Keiji Fukuda warned, “A post-antibiotic era- in which common infections and minor injuries can kill - far from being an apocalyptic fantasy is instead a very real possibility for the 21st
Prior to the discovery of antibiotics, a simple infection could kill. In the case of pneumonia, one out of three cases was fatal. With skin infections, the figure was one in nine.
The use of antibiotics has significantly decreased the number of deaths from bacterial infections. However, antibiotics are becoming less and less effective and few new drugs are available to replace them. Many of the harmful bacteria are now resistant to first line antibiotics - the medications of choice to fight specific infections. A growing number are also resistant to second and third line drugs and a few are resistant to last-resort treatments – these are known as “Superbugs”.
Conditions such as urinary tract infections, pneumonia, bloodstream infections and hospital-acquired infections are all examples of bacterial infections that have developed strong resistance to a number of antibiotics.
Resistance occurs when bacteria change in a way that makes an antibiotic ineffective. A change in the bacteria’s genetic structure can cause this. Bacteria can also exchange genes between each other, allowing resistance to pass from one bacterium to another.
How antibiotics become ineffective
Antibiotics work to kill harmful bacteria or render them ineffective. However, some bacteria may develop resistance to a certain antibiotic. When this happens, the non-resistant bacteria die, leaving only the antibiotic resistant bacteria. The more an antibiotic is used, the more likely this is to happen. Eventually, the only bacteria left are the resistant ones.
Every antibiotic has a limited lifespan. Over time, bacteria will develop resistance through a process of natural selection. However, other factors can accelerate the process.
One significant problem is the inappropriate use of antibiotics. Although the flu is a virus and not a bacterial infection, many patients demand an antibiotic when they get the flu even though antibiotics are ineffective in treating viral infections. According to the Food & Drug Administration, “every year, tens of millions of prescriptions for antibiotics are written to treat viral illness for which … antibiotics offer no benefit.”
People who stop taking their prescription before it has killed the infection or skip a dose can also help bacteria develop resistance.
Just as serious is the lack of control over the use of antibiotics. In some countries, pharmacies sell antibiotics over-the-counter without a prescription. In other parts of the world, people can purchase antibiotics on the street.
Self-medication creates greater opportunity for bacteria to develop resistance to one or more antibiotics and to spread this resistance to other bacteria. According to the World Economic Forum, in India “pharmacy sales of strong antibiotics, which should be a last line of defense, increased six fold from 2005 to 2010.” In a global economy, what happens in one region can rapidly spread to others.
History of antibiotics
Antibiotics are widely used with farm animals to promote growth and counteract unsanitary conditions. Of all the antibiotics sold in the United States, commercial animal production uses 80% of them. Approximately three-fourths of these antibiotics are identical or similar to those used by humans. Given the fact that antibiotic resistance bacteria can move from animals to humans, the Center for Science in the Public Interest considers the use of antibiotics with farm animals “among the practices of greatest concern for the development of antibiotic resistance.”
In order to deal with antibiotic resistant bacteria, we need to develop new antibiotics and we need to develop them on an ongoing basis; however, this is not happening. According to a recent New York Times article, we have not developed new classes of antibiotics since 1987.
The development of antibiotics has become scientifically more difficult and complex due to the increasing resistance of bacteria to multiple drugs. Research and development for a single drug can take 10 years or more and run as high as $800 million to $1.7 billion, with no assurance the FDA will approve the drug. People take antibiotics for only short durations (as opposed to drugs for chronic conditions) and physicians generally only prescribe new antibiotics when other antibiotics fail.
This reduces the size of the commercial market over which to recoup development costs. The development of drugs for chronic conditions is also far more profitable. As a result, pharmaceutical companies have placed their research dollars in the development of these drugs at the expense of new antibiotics.
According to the Infectious Disease Society of America, half of the large pharmaceutical companies in the United States and Japan halted or significantly decreased their antibiotic discovery efforts as of 1990.
The growing number of antibiotic resistant bacteria also has negative economic consequences. The World Economic Forum estimates the cost of treating antibiotic resistant bacteria, or superbugs, in the United States ranges from $21 to $34 billion per year.
Addressing the problem of antibiotic resistant bacteria will require a multifaceted approach and a global commitment.
What can be done?
The first step is to avoid exposure to harmful bacteria through good hygiene. Exposure to these bacteria is a serious problem in countries with contaminated drinking water, poor sanitation and a basic lack of personal hygiene. Poor sanitary conditions in hospitals also increase a person’s exposure to harmful or deadly bacteria.
Access to lab facilities and accurate testing of bacterial cultures can avoid the misapplication or inappropriate use of antibiotics.
Unfortunately, in some developing counties there are not enough labs to handle the demand. When health providers send bacterial cultures to these facilities, the lab often sends the test results back after treatment has already occurred. The Center for Global Development’s Drug Resistance Working Group calls the lack of lab facilities in some developing countries the “Achilles heel of global efforts to combat infectious diseases.”
Pharmaceutical companies also need to devote more resources to the research and development of new antibiotics. This will require initiatives that make the development of antibiotics and other forms of treatment more profitable for pharmaceutical companies. Tax incentives to encourage pharmaceutical companies to develop new antibiotics is one approach.
Another approach is public-private partnerships to support research and development. The Food and Drug Administration also needs to speed up the approval process for new antibiotics.
To this end, President Obama signed the GAIN Act (Generating Antibiotics Incentives Now Act) designed to incentivize pharmaceutical companies to develop new antibiotics. According to the PEW Charitable Trusts, as of May 2014, 17 novel antibiotics have qualified for incentives under GAIN. This is a good first step; however, the government needs to do more to streamline the approval process.
The reduction or elimination of antibiotics in animal food production is also critical. So is better regulation over the use of antibiotics in some third world countries.
We need to invest more resources in those countries that lack an adequate health care infrastructure, as well as build tracking systems to identify new strains of drug resistant bacteria. To do this, outside investment will be necessary.
If we want to avoid serious consequences in the future, we need to address the problem of antibiotic resistant bacteria now. The good news is everyone agrees a superbug crisis exists. The challenge we face is having the willpower, resources and capability to act on a global scale.
The original posting of this article was July, 2014. Now similar findings are described in a recent study found in the Economist, May, 2016.