Antibiotic Resistance - Why this is important to everyone now

Antibiotic resistance is a problem that we have been aware of almost since penicillin was first developed. Its the natural outcome of natural selection when bacteria are exposed to antibiotics, but now we are facing a moment when resistance may disarm even our newest and best antibiotics leaving us vulnerable to infections once again.

In the pre-antibiotic era infections were the most common cause of death. Pneumonia, Tuberculosis, and even infections from minor wounds were beyond the help of physicians. Even something as simple as strep throat could result in injury to the heart and death. Antibiotics changed that so successfully that people today forget what it was like to live in fear of even a small cut or fever. In 1900 Tuberculosis was the second leading cause of death in the U.S. yet only yesterday when I mentioned that I had to test a young woman for tuberculosis her response was "whats's that?". Antibiotics have been that successful.

Antibiotics have turned once deadly diseases into minor nuisances but they have been over used to the point that some of those bacteria are once again beyond the reach of modern medicine. New antibiotics have been developed but we are at a disadvantage. At most there may be a few thousand scientists around the world working on new antibiotics and it takes many years to discover, test, and bring a new antibiotic to market. Those physicians and scientists can only work so many hours. They need to sleep and eat and even occasionally take some time off. But there are trillions of bacteria working on defeating our efforts. They never get tired. They never go home, and they are willing to die for their cause by the billions to produce just one successful offspring who can defeat us and then multiply to produce trillions of its own offspring to spread this new drug resistant trait around the world. We reproduce every 20 years. They reproduce every 20 minutes. We are massively outnumbered and outgunned.

So why did this happen?  Some level of antibiotic resistance was inevitable. In fact there were antibiotic resistant bacteria before we even knew what an antibiotic was. Most antibiotics are derived from molecules that bacteria use to attack other bacteria. In this battle for supremacy among bacteria the bacteria which were under attack developed defenses against these weapons. When man discovered these molecules which we call antibiotics, there were already some bacteria in the world that had genes which made them resistant to the effects of these drugs, but they were relatively few in number.

Once we started using antibiotics routinely thousands of species of bacteria that normally reside in our bodies would occasionally get exposed to these drugs. Most would be killed but some would have the resistance gene which would allow them to survive and multiply to become the predominant bacteria.  Natural selection would allow the resistant bacteria to survive and pass on their genes to the next generation. Although humans and other animals can only pass genes to their offspring, bacteria can pass genes on to other bacteria and even to bacteria of other species. For this reason antibiotic resistance can travel quickly within and between different types of bacteria once it is established.

Antibiotic resistance has probably been around for billions of years but it wasn't a big problem until the past few decades. There are several reasons why antibiotic resistance has become so widespread.

1.  Use of antibiotics in livestock -  80% of all antibiotics manufactured are used to fatten perfectly healthy livestock. This encourages the rise of resistant organisms which then enter the food chain and our bodies.
2. Unnecessary use of antibiotics in people - Many of the antibiotic prescriptions written for people are written for illnesses that will not respond to antibiotics. As mentioned above, this encourages antibiotic resistance to develop among the bacteria that live harmlessly in and on our body and these bacteria may later pass that resistance gene on to bacteria which are causing an infection.

There is a lot people can do to help stem the wave of drug resistant bacteria.

• Look for meats and fish that say they are antibiotic free or grown without antibiotics
• Encourage your legislator to push for laws to reduce the use of antibiotics in livestock and fish and to prevent the importation of such products. Let them know this is important to you.
  
• Ask your physician if the antibiotic prescription they are writing is necessary or if its instead possible to take a more conservative approach and only use the antibiotic if the condition worsens.
• Don't pressure your physician to give you an antibiotic. Many prescriptions are written for things like colds and other viral illnesses which will not respond to an antibiotic because the physician feels its easier to just write the prescription than to fight with a patient who wants the antibiotic. Some patients with colds will say "but I just can't afford to be sick". The virus doesn't care. It's not going to die in the presence of an antibiotic just because you can't afford to be sick.
• Don't save or share unused antibiotics
• Don't throw antibiotics in the garbage or toilet. Discard them by bringing them to the pharmacy to be destroyed

• What do we do when antibiotics don’t work any more? - This TED talk addresses some of the issues mentioned above.
• The dangers of antibiotics-These lifesaving drugs are being misused and might stop working if we don’t take important precautions now -Consumer Reports
• Antibiotic Resistance - Centers for Disease Control
• Combating Antibiotic Resistance - FDA