Catching Up With Antibiotics

Evolution is an omnipresent, inevitable force that works on a vast, unappreciated timetable. Its reach unfortunately includes bacteria humans would be happy for it to ignore. Recently, the Center for Disease Control released its report on antibiotic resistance threats citing three “super-bugs” and 15 other bacteria that have evolved to an alarming level of treatment resistance and require immediate attention. Antibiotic medicine has failed to keep pace with pathogens that are quick to adapt to the current market of over-prescribed and misused antibiotic medicines. If the situation is left unchecked, we will soon face resistant strains that we are unable to defend against.The positive effect of antibiotics on modern medicine cannot be overstated. Whereas previously diseases like meningitis, pneumonia and tuberculosis often proved to be fatal, antibiotics now render these diseases manageable. Surgical operations once considered too risky are now routine; and the chances of post-surgical infection are minimal. Antibiotics are a mainstay of the modern medical world and save countless lives.The first few decades following the introduction of antibiotics saw continued interest in the research and development of new antibacterial medicines in the pharmaceutical industry. Now however, infectious disease is less of a priority in the developed world and pharmaceutical companies have dramatically shifted their focus to more lucrative lifestyle drugs and treatments for chronic diseases. Comparatively expensive initial investment must go into the research and development of antibiotics; with little guarantee of long term revenue due to the brief nature of the drug's prescription, it's no surprise businesses make the decision that keeps their bottom line in mind.Exacerbating the already deteriorating situation is the current widespread misuse of the drugs. Antibiotics must be taken for a specific amount of time – not simply until the patient starts feeling better. Too often treatment is stopped early, allowing the remaining bacteria to survive, strengthen, and wreak havoc on the next victim. Along with misuse is the rampant overuse of antibiotics. Patients adamantly request antibiotics to treat maladies that are often not bacterial but viral in nature – and doctors readily acquiesce to these demands. The frequent and improper prescription of antibiotics allow microbes to adapt and become resistant to the very medicines that would normally kill them.Importantly, the medical world accounts for only twenty percent of industry antibiotic sales. The remaining eighty percent is pumped directly into farm animals to promote growth and durability in environments that would otherwise be detrimental to the animals’ health. On the whole, bacteria are given near-ubiquitous chances to encounter and adapt to crucial antibacterial medicines – a situation that must be immediately stopped.The threat posed by antimicrobial resistance should not come as a surprise. As early as 1998 the World Health Assembly warned against the emerging threat and officially adopted a resolution urging action . Various organizations have since published policy recommendations, threat reports, and issued more calls to action (which have gone unanswered). There are a few exceptions in the mostly lackluster global response. Denmark led the way by voluntarily ending the use of antibiotics as growth-promoters in livestock – a ban later adopted by the European Commission in 2006. Denmark, Sweden and Norway have implemented sweeping oversight and compliance programs that have made noticeable inroads into the problem. More recently in 2011, the European Strategic Action Plan on Antibiotic Resistance was published, forming the most comprehensive policy recommendation to date . Other countries must take note and follow suit. A united effort is truly needed to make appreciable strides against this evolving threat. In an increasingly interconnected world, any benefit realized locally is often negated by international inaction on the matter. As soon as local advances are made against a certain microbe, trade and travel reintroduce different resistant microbial strains that must be combated. Furthermore, as the world population increases, so does global demand for food and medicine – both antibiotic intense industries. Without a comprehensive framework that monitors and controls antibiotic use in the developing world where much of the new demand resides, any advance on the antimicrobial resistance front in the developed world will be for naught.There is no single answer to a situation the CDC says could have “potentially catastrophic consequences” if left unaddressed. An immediate and systematic overhaul of the antibiotic framework and mindset is needed. Individually, we must practice better infection prevention. Doctors should prescribe antibiotics only when truly needed and emphasize the importance of taking the drugs for the fully prescribed term. Governments must act in concert to create incentives for pharmaceutical companies to renew their antibiotic development while also placing restrictions on the excessive use of antibiotics in livestock farming. Finally, structured oversight is needed from organizations like the CDC and the World Health Organization to properly focus efforts on the pathogens of greatest concern. Without a concerted effort, we risk falling behind against a tireless opponent in a race we cannot afford to lose.