Antibiotic Resistance - Part 1:
October 7, 2019
Antibiotic Resistance is a continually evolving problem in medicine and society. Historically, significant antibiotic resistance was confined to the hospitals and intensive care units. Over the past decade, these bacterial resistance issues have entered the everyday world with the likes of MRSA, methicillin resistant Staphlococcus aureus.
In the primary care, urgent and emergent care clinics, we are seeing children every day with MRSA abscess/skin infections. Fortunately, we still have 2 good oral antibiotics to fight this trouble maker. Hypothetically,
these antibiotics could start to fail. Then what? Death is the outcome for many untreatable serious infections. Why would this problem exist?
We have abused antibiotics in the patient care world for decades by over treating viral disease as bacterial. There has been an active push to reduce antibiotic usage, unfortunately, I still see too many patients coming in for follow up after being on vacation or out of town with 10 day courses of antibiotics for 2 days of viral cold symptoms. Statistics show that greater than 50% of prescriptions written are done so incorrectly. (CDC 2013 Report)
The use of antibiotics indiscriminately is a danger to everyone over time by allowing bacteria to spend time with these drugs learning how to evade them.
From an excellent review: "As early as 1945, Sir Alexander Fleming (founder of Penicillin) raised the alarm regarding antibiotic overuse when he warned that the "public will demand [the drug and] ... then will begin an era ... of abuses." The overuse of antibiotics clearly drives the evolution of resistance. Epidemiological studies have demonstrated a direct relationship between antibiotic consumption and the emergence and dissemination of resistant bacterial strains. In bacteria, genes can be inherited from relatives or can be acquired from nonrelatives on mobile genetic elements such as plasmids. This horizontal gene transfer (HGT) can allow antibiotic resistance to be transferred among different species of bacteria. Resistance can also occur spontaneously through mutation. Antibiotics remove drug-sensitive competitors, leaving resistant bacteria behind to reproduce as a result of natural selection. Despite warnings regarding overuse, antibiotics are overprescribed worldwide." (Ventola Part 1, 2015)
We are also using antibiotics like water in the animal/food industrial complex. We use more antibiotics in animals than in all Americans combined. Why? To enhance growth and control infections that stem from living in cesspools of close quartered environments. This practice is far from coming to an end.
According to the CDC: because of the link between antibiotic use in food producing animals and the occurrence of antibiotic resistant infections in humans, antibiotics should only be used in animals with veterinary oversight and only to treat and manage infectious diseases, not to promote growth.
A further problem comes from the economics of pharmaceutical development as written here: "Antibiotic development is no longer considered to be an economically wise investment for the pharmaceutical industry. Because antibiotics are used for relatively short periods and are often curative, antibiotics are not as profitable as drugs that treat chronic conditions, such as diabetes, psychiatric disorders, asthma, or gastroesophageal reflux. A cost-benefit analysis by the Office of Health Economics in London calculated that the net present value (NPV) of a new antibiotic is only about $50 million, compared to approximately $1 billion for a drug used to treat a neuromuscular disease. Because medicines for chronic conditions are more profitable, pharmaceutical companies prefer to invest in them." (Ventola Part 1, 2015)
This is a fundamental problem for the federal government to tackle. As the economics of development and production wane, we need the powers that be to start supporting innovation and development at the research level. The National Institutes of Health should start funding this research for human health protection.
What are the cold hard facts? Over 2 million Americans become infected with resistant bacterial organisms yearly. The subsequent death rate is over 25,000. That is a lot of loved ones to give up to a preventable issue. I am not comfortable with this for our society and especially not for my community.
Who is at the greatest risk? Patients with cancer, kidney disease receiving dialysis, immune system defects and those receiving major surgeries.
Next Week Part 2
Antibiotic resistance is a serious issue,