“When I woke up just after dawn on September 28, 1928, I certainly didn’t plan to revolutionize all medicine by discovering the world’s first antibiotic, or bacteria killer. But I suppose that was exactly what I did.”
These are the words of Alexander Fleming as he reflected on one of the most important scientific breakthroughs of the 20th century. Fleming’s discovery of penicillin ushered in a new age of medicine with the clinical use of antibiotics. Antibiotics slow growth or kill bacteria by interfering with critical processes like cell wall formation, and many believed such drugs could eliminate all bacterial diseases. But, not long after Fleming’s discovery came the rise of antibiotic resistance, a problem he rightly predicted would grow into a serious threat.
According to the Centers for Disease Control and Prevention (CDC), nearly 90,000 people die each year in the United States from antibiotic-resistant bacterial infections. That is more deaths than breast and prostate cancer combined. While MRSA (methicillin-resistant Staphylococcus aureus) is the most publicized of the antibiotic-resistant bacteria, it is just one of many. In fact, other bacteria that kill thousands of people each year include Pseudomonas aeruginosa, Klebsiella pneumoniae, and Acinetobacter baumannii. These bacteria are all resistant to at least some antibiotics, giving them the name “superbugs”, and the number of infections resistant even to antibiotics of last resort is increasing.
How did this happen? We did it to ourselves. Antibiotics are omnipresent in the Western world, overprescribed for patients who demand them even when they have viral infections. Then these same patients fail to take the prescription to completion, allowing some bacteria to survive. As a result, bacterial resistance can develop by mutations of genes that antibiotics target, or even from transfer of antibiotic-resistant genes between bacteria. This makes bacterial infections difficult to treat.
Resistant bacteria multiply and spread, since they are able to survive the constant antibiotic onslaught. When a serious bacterial infection develops, it is likely that the infection is due to antibiotic-resistant bacteria, which limits treatment options. This is especially a problem in hospitals, which are breeding grounds for resistant organisms. Hospitals have a large number of susceptible people with compromised immune systems, making a haven for sick people into a dangerous place.
Similarly, antibiotics are overused on cattle, often using them as prophylaxis, preventative medicine, on animals that are not sick, instead of only treating infected animals. All of these situations select for the bacteria that are resistant to antibiotics.
We’ve reached a tipping point. For a while we had many antibiotics in our arsenal to treat bacterial infections, so even if treatment with one antibiotic failed, there were other options. Unfortunately that is often no longer true, with resistance emerging faster than new therapies. The problem is that drug companies prefer to make medication for chronic conditions, such as cancer or heart disease, since their long-term treatment is much more profitable. In fact, according to the Food and Drug Administration (FDA), 21 new drugs have been approved for cancer treatment since the beginning of last year. In the same time frame, just one new bacterial treatment has been approved. As a result, we are left with too few antibiotic options and patients have to be put on antibiotics of last resort. These have worse side effects and require long-term treatments. And even these drugs sometimes fail. This leaves us unable to treat infections we once were able to cure.
And these infections aren’t just deadly; they’re costly too. The Alliance for Prudent Use of Antibiotics (APUA) estimates that antibiotic resistance costs the United States more than $20 billion each year. With a health and financial toll this great, something needs to be done.
What happens if we stand pat? We won’t return to the Middle Ages, where plague wiped out one third of Europe’s population. The truth is that many of the most dangerous and widespread bacterial pathogens that truly deserve the moniker “superbug” have been tamed, especially in the United States. This is because for the healthy person, pathogens like MRSA are not an immediate threat. But people hospitalized and already sick with other conditions are in danger of contracting bacterial infections we are sometimes powerless to treat.
It truly is a shame that we are constantly making medical advances in other fields, but have taken a step back in this area. Some potential solutions include treating infections with multiple antibiotics and offering greater incentives for the pharmaceutical industry to produce these products. Also, more specific therapies directed at toxins the bacteria produce could be used in conjunction with antibiotics to more effectively control infections. Stories about MRSA as a “superbug” are often overblown, causing unnecessary panic among people unlikely to get sick. Nevertheless, it rightfully draws attention to a public health problem that requires new solutions. The appropriate response is concern and action. But if we continue to ignore the problem, it can only get worse.