Concerns about drug-resistant "superbugs" are becoming more acute as antibacterial resistance across the globe continues to grow year after year. Experts such as Tom Frieden, Director of the CDC, worry that the overuse of antibiotics could lead to the next global pandemic by creating microbial illnesses that cannot be controlled by modern medicine. Here's what you need to know about antibiotic resistance:
Before antibiotics were discovered in 1928, bacterial infections were the cause of many preventable deaths. For every thousand women who gave birth, five would die. 30% of pneumonia victims died. One out of nine people with a skin infection, even from a simple scratch or bug bite, would die. 90% of children who contracted bacterial meningitis died, and among the 10% of children who lived, most faced severe disabilities for the rest of their lives. The discovery of penicillin and other antimicrobial drugs that followed was undoubtedly one of the most important breakthroughs in medical history. Antimicrobial drugs fall under one of several categories: antibacterial, antiviral, antifungal, and antiparasitic.
- Antibiotics are defined as chemicals that suppress or kill bacteria, and are usually natural compounds discovered in other microbes such as soil or fungi.
- The first true antibiotic, penicillin, was invented by Alexander Fleming who was a professor of bacteriology at St Mary's Hospital in London at the time. While experimenting on the influenza virus, he discovered that a lab culture plate of staphylococcus infested with mold had created a bacteria-free zone wherever the "mold juice" touched it.
- Penicillin was crucial for treating soldiers during World War II, reducing amputations and mortality by curing battle wound infections and pneumonia. Penicillin was made accessible for the public by the late 1940's.
- Most penicillin is derived from a single moldy cantaloupe from Peoria, Illinois the 1940's. Since then, the particular strain of penicillium from that cantaloupe has been replicated many times and remains a reliable source of penicillin.
- As early as 1945, Alexander Fleming warned us that over time, antibiotics could likely lose their effectiveness.
- Antibiotics are also used in the agricultural industry, not just to fight off infections, but primarily for livestock animals to gain weight--a side effect of many antibiotics.
Antibiotic resistance is caused by simply using antibiotics, but it is amplified by antibiotic overuse. Antibiotic resistance occurs when the DNA of a bacterium mutates in such a way that it can survive an antibiotic treatment. One bacterium can reproduce millions more within a single day. Patients with infections brought about by drug-resistant bacteria tend to have worse clinical outcomes and an increased risk of death. These types of infections also consume more healthcare resources than infections caused by the same types of bacteria that are not resistant because they require longer, more intense forms of treatment.
- In the United States alone, 2 million people a year contract antibiotic-resistant infections.
- 23,000 people die each year in the US from antibiotic resistant infections.
- According to the CDC, antibiotic resistance results in an additional $20 billion per year spent on healthcare
- Many infections acquired in hospitals are caused by highly drug-resistant bacteria
- Between 1980 and 1987, cases of penicillin-resistant pneumonia remained stable at approximately 5 percent of strains. By 1997, 44% of pneumonia strains were showing resistance to antibiotics.
- Instances of drug resistant bacteria-caused infections are now spreading to the developing world, where access to antibiotics is often abused.
The director of the Center for Disease Dynamics, Economics and Policy (CDDEP), Ramanan Laxminarayan, attributes the global rise in resistant bacteria to overuse of antibiotics. The CDC estimates that over half of antibiotics prescriptions given to patients visiting a US clinic are inappropriate. The majority are for patients seeking care for respiratory symptoms that are most commonly caused by viruses, which are unaffected by antibiotics. Global use of antibiotics rose by 36% between 2000 and 2010, with five countries (Brazil, Russia, India, China and South Africa) responsible for more than 75% of that growth.
- Between 1997 and 2010, an estimated $500 million was spent on unnecessary antibiotics prescribed for sore throat symptoms alone.
- 80% of children's ear infections are caused by viruses; however 70% of children with ear infections are prescribed antibiotics.
- A study from Harvard found that doctors prescribed antibiotics as treatment for 73% of acute bronchitis cases, despite the fact that antibiotics are not at all recommended for treatment of this illness.
- India is the global leader of antibiotic overuse, where the average Indian citizen takes 11 antibiotic pills a year.
- Researchers have found E. coli bacteria in samples from India to show especially high rates of resistance.
- In countries where citizens are properly educated about harmful antibiotic overuse, such as Sweden and Denmark, the rate of E. coli resistance is about zero percent.
- By 2014 in India, the particularly dangerous pneumonia strain Klebsiella pneumoniae had a 75% resistance rate to the last-resort class of antibiotics.
- In Europe the resistance rate of Klebsiella pneumoniae is under 5%.
- According to Laxminarayan of the CDDEP, “No matter how many new drugs come out, if we continue to misuse them, they might as well never have been discovered.”
Laxminarayan of the CDDEP emphasizes the importance of educating the public about the dangers of overuse of antibiotics. As seen with the disparity in rates of antibiotic resistance in India versus Sweden, educational efforts could go a long way in decreasing antibiotic overuse and bacterial resistance to these drugs. Along with several other researchers, Laxminarayan believes that it is a far bigger priority to prevent further increase of drug resistance than it is to continue investing in development of new antibiotics. He claims that around 95 % of current spending dedicated to antibiotic resistance is used for research to find new drugs. He believes this should be reduced to just 40%.
- The federal government recently announced the creation of the Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria, chaired by Dr. Martin Blaser who authored the book Missing Microbes: How the Overuse of Antibiotics Is Fueling Our Modern Plagues.
- In an effort to promote the use of antibiotics only when they are absolutely needed, the European Commission is offering a 1 million euro prize in a challenge to develop a rapid, cost effective test that can identify patients with respiratory infections who can be treated safely without antibiotics.
- Tom Frieden of the CDC recently announced the organization's plans to limit the existence of drug-resistant bacteria and overuse of antibiotics in hospitals through stricter prevention methods and tracking.
Sources: https://www.motherjones.com/blue-marble/2013/10/scary-truth-about-antibiotic-overprescription ; https://www.usatoday.com/story/news/nation/2014/07/22/antibiotic-resistance-bacteria-drugs-cdc-lab-safety-mers-anthrax/13005415/ /; https://www.wired.com/2015/09/us-finally-taking-action-antibiotic-resistance/ /; https://qz.com/505556/the-frightening-spread-of-antibiotic-resistance-around-the-world-visualized/ /; https://www.cdc.gov/getsmart/community/about/fast-facts.html ; https://timesofindia.indiatimes.com/india/India-becomes-worlds-largest-consumer-of-antibiotics/articleshow/38251650.cms