Many of us who get the flu this winter will demand antibiotics from our doctors. And hopefully, your doctor will turn you down.
Antibiotics, which kill bacteria, don't cure the flu. That's because the flu is caused by a virus, not bacteria. So your doctor would be prescribing an unnecessary drug.
But in a broader sense, your doctor's refusal to prescribe you antibiotics for the flu would do us all a favor. That's because unnecessary antibiotic use renders the drug ineffective for when it's really needed.
This threat is growing. In a recent Medium article, Wired science blogger Maryn McKenna describes a disturbingly plausible picture of a world in which antibiotics have become markedly less effective. That future is the focus of McKenna's interview this week on the Inquiring Minds podcast:
"For 85 years," McKenna explains on the show, antibiotics "have been solving the problem of infectious disease in a way that's really unique in human history. And people assume those antibiotics are always going to be there. And unfortunately, they're wrong."
Here are some disturbing facts about the growing problem of antibiotic resistance, courtesy of Mother Jones:
1. In the U.S. alone, 2 million people each year contract serious antibiotic-resistant infections and 23,000 die from them.
These figures comes from a new report from the U.S. Centers for Disease Control and Prevention (CDC) on antibiotic resistance that, for the first time, uses a blunt classification scheme to identify "urgent," "serious," and "concerning" threats from drug-resistant bacteria. The CDC lists three urgent threats: drug-resistant gonorrhea, drug-resistant "enterobacteriaceae" such as E. Coli, and Clostridium difficile, which causes life-threatening diarrhea and often is acquired in hospitals. Clostridium difficile kills at least 14,000 people a year.
2. We've been warned about antibiotic resistance since at least 1945. We just haven't been listening.
3. Antibiotic-resistant strains of bacteria are on the rise.
Clearly, antibiotic resistance is not new. Nonetheless, the frequency of antibiotic resistance events is increasing. For example, from 1980 to 1987, cases of penicillin-resistant Streptococcus pneumoniae (the bacteria that causes pneumonia) remained steady at about 5 percent of all strains. By 1997, 44 percent of strains were showing resistance. Similarly, Enterococci bacteria can cause urinary tract infections and meningitis, among other diseases), and in 1989, fewer than 0.5 percent of strains found in hospitals were resistant to antibiotics. Four years later that number was at 7.9 percent, and by 1998, some hospitals reported levels as high as 30 percent to 50 percent. "The more antibiotics are used, the more quickly bacteria develop resistance," says the CDC.
4. There has been a steady decline in Food and Drug Administration (FDA) approvals for new antibiotics.
Even as more bacteria are becoming resistant and our treatments are becoming less effective, we're also producing fewer new drugs to combat infections.
Why has this happened? "There's a kind of curve to antibiotic development," says McKenna, noting there was a boom in the 1950s, when Eli Lilly collected samples of biological materials from all over the world to capture antibiotic properties in natural substances. By the 1980s, much of the low-hanging antibiotic fruit had been harvested. Now, the development of new treatments is becoming increasingly difficult and costly, even as pharmaceutical companies are cutting research and development budgets and outsourcing drug discovery more and more. "The faucet from which [antibiotics] come has been turned down and down and down and now it's just a drip," McKenna says.
5. Up to half of all antibiotic prescriptions either aren't needed or are not effective.
A huge part of our problem is that we're misusing and abusing antibiotics. "Resistance is a natural process," says McKenna, but "we made resistance worse by the cavalier way that we used antibiotics, and still use them." Sick patients pressure their doctors for drugs, and doctors too often yield and dash off a script. A recent study found that doctors prescribed antibiotics 73 percent of the time for acute bronchitis, even though, as Mother Jones' Kiera Butler reports, antibiotics are not recommended at all for this condition.
Almost one in five emergency room visits resulting from adverse drug events are caused by antibiotics, the CDC says. Children are the most likely victims. Although antibiotics are generally safe, they can cause allergic reactions and also can interact with other drugs, harming patients who are vulnerable because they already suffer from other medical conditions. So if we stop over-prescribing antibiotics we'd also lessen adverse drug effects.
6. It's not just human medical misuse—a large volume of antibiotics is inappropriately used in livestock.
Antibiotics are heavily used in the agricultural industry—more antibiotics are used to treat animals than to treat people. While livestock drugs are used to fight infections, they are often fed to animals in smaller doses to encourage weight gain and growth—a practice, the CDC says, that is "not necessary" and "should be phased out." A recent draft document from the FDA similarly states that "in light of the risk that antimicrobial resistance poses to public health, the use of medically important antimicrobial drugs in food-producing animals for production purposes does not represent a judicious use of these drugs." For now, though, the FDA's approach to curbing this threat has been limited to issuing voluntary guidelines.
7. Before antibiotics, death rates were much higher from very common occurrences like skin infections, pneumonia and giving birth.
In her Medium article, McKenna gives some disturbing stats. Before antibiotics, just giving birth could be deadly: Five out of every thousand women who had a baby died. Pneumonia killed 30 percent of its victims. And "one out of nine people who got a skin infection died, even from something as simple as a scrape or an insect bite." If we run out of antibiotics, our future looks rather bleak.
8. The next major global pandemic may involve an antibiotic-resistant superbug.
"Plagues still really have power and almost a hundred years later, we shouldn't think that we're immune to them because we're not," warns McKenna. For instance, tuberculosis kills more than a million people a year, and it is becoming increasingly drug-resistant, says the World Health Organization.
Bacteria poses a threat even with viral infections. Viruses can weaken our immune systems just enough to allow bacteria to take hold. Death results from secondary bacterial infections that, at least until recently, were largely curbed by effective antibiotics.
So are we doomed to recede back into a time when infections were the most significant health threat that our species faced?
According to McKenna, it is unclear whether we can fully curb antibiotic overuse. The better approach is to get the drug industry research engine firing again. "There's a really active discourse around what's the best way to get pharmaceutical companies back into manufacturing antibiotics," she says.
Our future, then, once again lies in the hands of scientists, whose quest to find new treatments for drug-resistant bacteria is now of the utmost importance.
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