Join us for the free Community Medical School lecture “Battle of the Bacteria: Antibiotic Resistance and the Evolution of Superbugs” by Dr. Alston on April 4, 2017, 6:00 p.m. to 7:30 p.m. at the Robert Larner College of Medicine at the University of Vermont. Click here for event details. No pre-registration is required.
Antibiotic resistance is a growing, global public health problem of enormous proportions.
The modern antibiotic era is only about 75 years old, younger than many of the patients for whom we care. In this short time, many bacteria, viruses, and fungi have evolved complex mechanisms of resisting the effects of antibiotics. This has not happened suddenly like an outbreak, but rather as a slow, progressive, and relentless evolution.
In 2017, we have reached the point where increasing antibiotic resistance fuels life-threatening infections. While there are dozens of antibiotics commercially available, many of them overlap in terms of their mechanisms and vulnerability to evolving resistance mechanisms. Physicians frequently end up having to prescribe a greater number of more expensive and potentially more toxic antibiotics to treat what could have been easily dealt with in the past. This creates a situation where, despite 75 years of remarkable progress in antibiotic development, we are threatened with the prospects of a post-antibiotic era.
People do not become resistant to antibiotics, the bugs do. Indeed, antibiotics do not treat us directly; rather they inhibit or kill the microbes that infect us, as well as those with which we live harmlessly. Remember that human beings do not live alone, but are inhabited both externally and internally by hoards of microorganisms greater in number than our own cellular makeup. When we take an antibiotic, we are not sterilized or made germ-free. Rather, the extremely diverse microbial flora that inhabits us shifts towards more antibiotic-resistant species. Bacteria exchange genetic information promiscuously among themselves, sharing the blueprints for how to evade antibiotics. Bugs that have been exposed to antibiotics and have developed resistance can then be spread to other people via direct contact. Individuals harboring antibiotic-resistant bacteria may get admitted to a different hospital or even jump on an airplane, all the while innocently carrying their baggage of antibiotic-resistant tenants.
Antibiotics are all limited by the amount of time they are on the market and the frequency with which physicians prescribe them. Each dose contributes, in a very real way, to their demise. A drug which could cure an infection in the 1950s may no longer even be taught in medical school. And the antibiotics we use today may well be obsolete in the coming years. No antibiotic has ever been developed for which resistance has not evolved.
So what do we do?
While we cannot prevent the evolution of resistance entirely we can certainly slow the process, allowing more time for new drugs to be developed.
As a culture, we must come to think of antibiotics as being different than other types of medications. Physicians must learn to improve their prescribing of antibiotics. Patients should not demand an antibiotic if their physician believes it will not be effective. Antibiotic use in livestock needs to be reduced. Drug companies need incentives to pursue the development of new antibiotics, which are typically not as profitable as other drugs. Hospitals must slow the transmission of antibiotic-resistant bacteria among patients. Vaccines for common, antibiotic-resistant infections need to be developed. The tests used to diagnose infections need to be faster and more sensitive to help guide our antibiotic choices. We need to figure out ways to safely restore our microbial flora after it has been damaged by a course of antibiotics.
The time to act is now, while we can still treat common infectious diseases.
Wallace Alston, MD, is Medical Director of Infection Prevention at the University of Vermont Medical Center. He is an infectious disease specialist and epidemiologist. He is also a professor in the Larner College of Medicine at UVM.