Antibiotic drug resistance, like advancing age, continues to march slowly and dully towards calamity. The most recent indignity is the movement to the dark side of a bacterium that is a common cause of diarrhea, including bloody diarrhea: Shigella. In the U.S. each year, about 500,000 cases are reported resulting in a few thousand hospitalizations. Death is rare but discomfort common.
This venerable pathogen like so many others has sprinted past the reach of a commonly used antibiotic—ciprofloxacin—making treatment even more challenging. With this big step, Shigella has joined the ranks of countless other bacteria, viruses, and fungi that have entered the netherworld of antibiotic resistance.
An interesting and overlooked fact in this seductive and inviting news is the fact that there is no need to treat Shigella. Indeed for some related bacterial infections that cause diarrhea, there is a suggestion that the use of antibiotics prolongs rather than curtails the period of illness. In normal people with normal intestinal tracts, the best treatment is time, fluids, and of course heavy doses of self-pity. Diarrhea, surely, is among the most humbling of all routine human experiences.
So what’s all the fuss? There are two very different answers to this one: first, drug resistance stories sell. An example of this phenomenon is the fact that you are reading this piece even though—in all likelihood—you and no one you know has ever been particularly ill from Shigella. The nefarious media knows this and that you can’t resist yet another tale of the approaching dark winter reigned over by a swarm of sinister superbugs.
Which leads to the second point. The fact that we have an infection, that doesn’t need treatment yet, is acquiring drug resistance anyhow reflects a much larger problem than the usual. Drug resistance happens predictably; and the more you treat an infection with an antibiotic, the faster the resistance occurs—indeed, penicillin resistance was reported within a year or two after its introduction. Antibiotics are by definition doomed by their own success.
The crossing over of Shigella to even more resistance—despite the fact that we don’t treat it very often—changes up the usual rules. OK, some people with Shigella do take antibiotics—they have some old medicine in the house left over from an intrepid youthful backpacking adventure or else call a doctor with a tale of woe and get a prescription. But usually those with Shigella don’t see a doctor—the time from illness to realizing you are more ill than usual to getting to a doctor is so compressed that by the time you decide to make an appointment, you already are better.
Rather, the standard see-bug-treat-bug-see-resistance trope is now a much more ominous tale of collateral damage. The Shigella resistance is a story not about one bacterium but about the collective ecosystem of the 300 million human large intestines in the U.S., all of which are seeing antibiotics for good reasons and bad reasons, as well as passed on to us from animal feed and maybe even the water we drink.
It means we have passed a tipping point of sorts, a moment when the trillion or so bacteria per large intestine, multiplied by 300 million citizens have moved on from a class of antibiotics. We—or our oddly called intestinal “flora” (nothing floral about it, really)—have just said no to drugs. Drug resistance ‘R’ Us.
Which is calamitous surely but not in the way that you fear. It is simply another area that needs attention and thought but represents little immediate threat. Part of the strategy is the stink bomb of news and doomsday forecasts that already has altered prescribing behavior.
See, antibiotics and bacteria, vicious foes, have very short memories. They forgive. And so with the news that ciprofloxacin isn’t likely to work will come less use of ciprofloxacin. And—mirabile dictum—with less use, soon resistance rates will fall. And then the antibiotic will be used more and resistance will rise and then less and then more and so on. In other words, it’s a problem with a reasonable solution—unlike the problem of advancing age.