The American Interest
Analysis by Walter Russell Mead & Staff
We Now Live in a Post-Antibiotic Era

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We’re rapidly approaching the point where we’ll no longer be able to treat many of our most deadly infections. PBS has a detailed, fascinating, and alarming interview with Dr. Arjun Srinivasan, an associate director at the CDC, about rising resistance to antibiotics among Western populations. Dr. Srinivasan points out that antibiotics have been a key part of treating infections that arise after many different medical procedures, from cancer treatment to organ transplants. Without antibiotics, patients are vastly more likely to die from infections in the wake of those procedures. And we’re increasing without antibiotics:

The more you use an antibiotic, the more you expose a bacteria to an antibiotic, the greater the likelihood that resistance to that antibiotic is going to develop. So the more antibiotics we put into people, we put into the environment, we put into livestock, the more opportunities we create for these bacteria to become resistant. …We also know that we’ve greatly overused antibiotics and in overusing these antibiotics, we have set ourselves up for the scenario that we find ourselves in now, where we’re running out of antibiotics [...]

We’re here. We’re in the post-antibiotic era. There are patients for whom we have no therapy, and we are literally in a position of having a patient in a bed who has an infection, something that five years ago even we could have treated, but now we can’t.

Dr. Srinivasan lays out some solutions that could help reduce the scope of this problem. Some are small and individual, like doctors and nurses washing their hands after treating an infection and being more careful when prescribing antibiotics. Others are more macro level. For instance, Dr. Srinivasan recommends that we allow very sick patients who have built up resistance to all the standard antibiotics to use antibiotics that may have worse side effects than normal. Here as elsewhere we need to update our regulatory structure to make it more responsive to changing conditions.

And of course, he argues we need much more research into and awareness of this problem. Read the whole thing.

[Image of Bacteria from Shutterstock]

Published on October 26, 2013 3:00 pm
  • wigwag

    One problem is that there is not much incentive for pharma to invest in discovering new antibiotics. The risks are too high and because of the pricing structure that everyone from government to consumers expect for antibiotics, the return is too small. There are ways to address this issue but each alternative, from extending the patent life for new antibiotics to accepting new antibiotics with a greater side effect profile are problematic.

    • Waldemar Ingdahl

      The pharmaceutical industry is indispensable, because success in drug development is seldom achieved without persistent risk-taking.

      • wigwag

        I agree. One big problem, I think, is that Sweden and much of the rest of the developed world refuses to pay enough for most new medicines for the companies that take enormous risks to invent and test those medicines to earn a reasonable return.

        Only the United States provides enough of a profit margin to make the search for new pharmaceutical treatments possible. This reality distorts the market in many negative ways.

        Let me give you a Scandanavian example. Novo-Nordisk, headquartered in Denmark, is a leader in discovering new treatments for diabetes (it is the second largest insulin producer in the world after Eli Lilly). Virtually all of Novo-Nordisk’s profit comes from American sales. It makes little to no profit selling products in Europe.

        Is it any wonder that it has less incentive to discover new drugs than it otherwise would if only it could get a reasonable return for European sales?

        • Waldemar Ingdahl

          I agree. This is a big problem Europe has created, and the pharmaceutical market needs to be addressed. Unfortunately, it looks like Europe is trying antibiotic austerity as a strategy while not pointing on further research.

  • Waldemar Ingdahl

    The debate over antibiotic resistance often pits individual choice against public health. Patients are said to demand too many antibiotics from their doctors. Both the Food and Drug Administration and the CDC advocate reducing the use of antibiotics in order to prevent resistant bacteria. Demand-side policy is trying to slow down bacteria’s strength — a rapid evolutionary process — and is not necessarily the best solution.

    http://www.american.com/archive/2013/june/how-to-halt-the-spread-of-superbugs/

    • theresanursemom

      Doctors are also pressured to give antibiotics for every sniffle, or boil, or break in the skin a patient has. Otherwise, they will be hearing from a lawyer, what do you expect them to do? I’ve seen hospice patients on antibiotics and lots of 80+ year old patients with multiple serious problems who should’ve been on hospice, given antibiotics because their families demanded it. The public’s unrealistic expectations are a HUGE part of the antibiotic resistance we are seeing today. We’ve screwed ourselves royally on this one, I’ve seen it first hand again and again.

      • Waldemar Ingdahl

        The relationship between prescribed antibiotics and the spread of resistance is not clear. Here in Sweden, we have one of the lowest intakes of antibiotics in the world. Prescriptions declined by about 30 percent between 1992 and 2011. Yet the number of outbreaks of antibiotic-resistant bacteria have increased. The connection between antibiotic intake and the development of resistance is more complex than a mere link between consumption and resistance.

  • Bruce

    It takes over a billion dollars to get a new antibiotic to market and FDA approved. There are many failures along the way for drug companies as well. It’s a complex issue, but you probably won’t be seeing too many new super antibiotics that work on these resistant bacteria.

    • Waldemar Ingdahl

      That’s why more research on nanomedicine, bacteriophages and regarding the bacterial DNA-code is needed.