Few drugs today can compare to antibiotics in terms of sheer impact on modern medicine. With the widespread introduction of penicillin in the 1940s, previously serious and deadly infections such as pneumonia and bacterial meningitis suddenly became curable in only a few days’ time. Contemporary news outlets hailed the advent of this “miracle drug” which landed its discoverer, Alexander Fleming, a Nobel Prize in 1945.
Now fast-forward 70 years. During the time that you were reading the above paragraph, one more person in the United States became infected with antibiotic-resistant bacteria, according to a recent CDC report. By the time you are done with this article, seven more Americans will have contracted antibiotic-resistant infections. By tomorrow, at least two people will have died as a direct result of their infections — a sobering indication that the medical “miracle” we have enjoyed thus far may be short-lived.
Antibiotic resistance, described by one UK health administrator as a “ticking time bomb,” is on track to become one of the greatest threats to human health in the near future without direct and immediate intervention by researchers and policymakers. Given the sheer ubiquity of these drugs in industry and health today — a pack of potentially life-saving antibiotic cream for skin infections costs about seven dollars at Walmart — it’s easy to see why.
“I think that there’s a real possibility … that there’s going to be a post-antibiotic period,” said Simon Levin, professor of ecology and evolutionary biology at Princeton University. “And I don’t think people realize how scary that would be.”
A Two-Fold Problem
Bacterial resistance to antibiotics is a well-known biological consequence of antibiotic use. The mechanism is simple: when you hit a bacterial population with antibiotics, chances are you’ll leave behind a few stragglers who have managed to acquire resistance either through mutation or through sharing genetic material with other resistant cells. Leave the stragglers alone, and they’ll multiply into a colony full of resistant microbes.
Although resistance is a natural biological phenomenon, its onset can be greatly expedited by overuse and misuse of antibiotic drugs. In fact, it already has. In a recent study published in The Lancet Infectious Diseases, a leading infectious disease journal, researchers found a 36% global increase in antibiotic use between 2000 and 2010. Alarmingly, the findings also suggest a correlation between a 45% jump in carbapenem consumption — widely considered to be a “last-resort” antibiotic — and the recent emergence of carbapenem-resistant strains in several developing nations.
There’s a real possibility that there’s going to be a post-antibiotic period, and I don’t think people realize how scary that would be.
Levin, an author of the study, describes the problem of antibiotic resistance as two-fold: not only are we diminishing the efficacy of current antibiotic drugs through overuse, we aren’t discovering new drugs to replace the old. The inevitability of bacterial resistance demands a constant flow of new drugs into the “antibiotic pipeline,” which in recent years has been little more than a trickle.
“There are several reasons for this,” Levin said. “[One reason is that] we’re just not coming [up] with fundamentally new chemical mechanisms by which new antibiotics would work.”
Thomas Van Boeckel, the primary author of the study, agrees, adding that many of the new drugs developed recently are chemically similar to older drugs. This means that bacterial strains already resistant to old drugs won’t have to do as much biological tweaking to get past the new drugs.
“Most of the low-hanging fruits have already been picked up,” Boeckel said.
Moving Forward
It seems that one of the most obvious ways to combat resistance, then, would be to “refill” the antibiotic pipeline through increased funding. According to Boeckel, this would necessitate a redirection of economic incentives towards antibiotic research, of which little currently exists for pharmaceutical companies.
However, new drug development must also be coupled with more responsible management of the antibiotics we still have. This would include measures to minimize over-prescription of antibiotics through more rapid diagnostic tests for bacterial infections, so that antibiotics aren’t inadvertently wasted on people with nonbacterial infections. Another major target for conservation efforts is the livestock industry, which accounts for 80% of total antibiotic sales in the US due to the drugs’ supposed growth-promotion capabilities.
Most of the low-hanging fruits have already been picked up.
Moreover, the old adage that “an ounce of prevention is worth a pound of cure” especially applies here. Basic improvements in hygiene infrastructure, vaccination coverage and other preventative measures, particularly in developing nations, are just as important as medicinal innovation and policy changes in industry and healthcare, Boeckel adds.
“We can’t only rely on innovation to keep people healthy,” Boeckel said. “I mean, maybe we’ll find [another wonder-drug], but in the absence of such discovery, we should work with a combination of things trying to improve prevention and extend the lifespan [of current drugs].”
“I’m optimistic that we can find our way through this,” Levin adds. “But it’s going to involve effort on multiple fronts.”