05.01.14 3:55 PM ET
When Antibiotics Don’t Work, It’s Everyone’s Problem
There are certain things that no contemporary medical provider should have to do without. Some treatments are so indispensable to the practice of modern medicine that trying to care for people without them is essentially inconceivable. For example, I cannot imagine trying to treat a diabetic patient without insulin, or an asthmatic patient without bronchodilators. And I certainly can’t imagine what it would be like to practice medicine without recourse to antibiotics.
Common infectious diseases comprise a significant proportion of my patient encounters as a pediatrician, and trying to cure pneumonia or impetigo without the ready arsenal of antibiotics I have at my disposal is a problem I can scarcely begin to consider. Though I am an uncompromising tightwad when it comes to prescriptions for amoxicillin or Cipro (the broader the spectrum, the tighter my grip), knowing they are available and effective should I need them is a fundamental element of my ability to care for people.
It was therefore with genuine dismay that I read of a new report from the World Health Organization (WHO) about the burgeoning problem of antibiotic resistance. It is, unfortunately, not some far-off challenge to be solved by a future generation, but an imminent threat right now, and one that demands immediate action. Without diligent efforts to curtail the indiscriminate and irresponsible use of antibiotics, we face the very real possibility of a world in which they no longer work.
This is no idle concern. Already I have developed a knack for recognizing skin infections caused by methicillin-resistant Staphylococcus aureus (or MRSA), so named because the bacteria are resistant to an antibiotic specifically developed to combat them. When a patient comes in for treatment of random boils or abscesses seemingly out of nowhere, MRSA is at the top of my list of diagnoses to consider. Thankfully, there are antibiotics I can prescribe that usually work against these infections. For now.
However, as the WHO report makes clear, antibiotic resistance is a growing problem that threatens the entire globe. Policies and practices within our own country must be revised, because it affects us here. Infection with a resistant bacterium can strike a healthy young person in the United States just the same as an infirm person anywhere in the developing world.
Various different antibiotic-resistant infections are already widespread, though some remain limited to hospitalized patients at this time. However, resistance to certain commonly used antibiotics to combat urinary tract infections has become so common that in many parts of the world more than half of patients will not be cured by them. In many countries, including developed nations like Australia, the United Kingdom and next-door Canada, gonorrhea (a disease that afflicts a million people around the world on any given day) has developed resistance even to the antibiotics of last resort used in its treatment.
Facts like these are why I get immensely frustrated when I encounter lazy medical providers who scribble out a prescription for a Z-Pak for every patient who smiles the right way. Even though I know it makes some people happy to leave my office with a script, I am professionally obligated to be parsimonious with a resource as precious as effective antibiotics. Hopefully, with increasing awareness of the antibiotic-resistance problem will come less pressure on providers to err on the side of treating disgruntled patients.
But it’s not merely medical providers who must exercise restraint when doling out antimicrobials. The farming industry has indiscriminately given cattle, hogs, and poultry antibiotics for years, because doing so makes them gain weight faster. As understandable from an industry perspective as this practice may have been, profligate use of these vital medications must end. (As a consumer, I make a point of purchasing meat and dairy products with a label stipulating they came from animals not treated with antibiotics.) I was heartened to read of a new program implemented by the Food and Drug Administration last year meant to encourage a voluntary phasing-out of this practice. I hope it is successful on a large scale, and would support a more mandatory plan if not.
In addition to more prudent behavior by medical providers and farmers alike, there must be renewed attention to the development of newer, better antibiotics. With a more nuanced understanding of how our bodies can live in harmony with the bacteria that populate them (a person carries more bacteria around than actual human cells by a factor of 10 to 1) and the dangers that come from disrupting this balance, so too may come insights into exploiting this relationship to keep pathological strains at bay. However, there was a 40-year gap in the development of new antibiotic classes, and discovery of new molecules is as pressing a medical concern as any other area of pharmaceutical research.
I am cautiously optimistic that, by stewarding the invaluable treasure we have in effective antibiotics and investing wisely in increasing our stores, we can avert the disaster of their loss. We really cannot afford to do otherwise.