Wednesday, November 14, 2012

A Health Crisis In Slow Motion




# 6715


Although truly the miracle drugs of the 20th century, antibiotics are a fragile armamentarium, and over the past 70 years we’ve learned just how quickly bacteria can evolve to evade their antimicrobial effects.


Antimicrobial resistance is a huge and growing threat to public health – perhaps the greatest threat of all


Yet it is largely unappreciated by the public because its progression has been gradual, the loss of antibiotics incremental, and so far at least . . . there have always been replacement drugs available when an antibiotic has failed.


But the number of new antibiotics in the pipeline are desperately few, and the frequency of newly emerging resistant bugs has increased in recent years. 


Last March, the Director General of the World Health Organization, Margaret Chan - in a keynote address to the Conference on Combating Antimicrobial Resistance in Copenhagen - painted a bleak picture of the future of antibiotic availability if action is not taken.


The D-G’s entire remarks may be viewed on the WHO’s website at Antimicrobial resistance in the European Union and the world, but I’ve excerpted a few choice statements below.


If current trends continue unabated, the future is easy to predict. Some experts say we are moving back to the pre-antibiotic era. No. This will be a post-antibiotic era. In terms of new replacement antibiotics, the pipeline is virtually dry, especially for gram-negative bacteria. The cupboard is nearly bare.




A post-antibiotic era means, in effect, an end to modern medicine as we know it. Things as common as strep throat or a child’s scratched knee could once again kill.


Some sophisticated interventions, like hip replacements, organ transplants, cancer chemotherapy, and care of preterm infants, would become far more difficult or even too dangerous to undertake.


This week (Nov. 12th-18th) marks the CDC’s fifth annual Get Smart About Antibiotics Week, which coincides with observances in many regions around the world, including  European Antibiotic Awareness Day, Australia's Antibiotic Awareness Week and Canada's Antibiotic Awareness Week.


The theme of this campaign is the smart usage of antibiotics, and educating the public on the fact that these drugs won’t cure a viral infection, and their overuse leads to resistance.  



Get Smart. Take a look at this chart to find out which upper respiratory infections are usually caused by viruses — germs that are not killed by antibiotics. Talk with your doctor about ways to feel better when you are sick. Ask what you should look for at home that might mean you are developing another infection for which antibiotics might be appropriate.


For some ideas about what to do for these types of illnesses without taking antibiotics, the CDC has a Symptom Relief webpage.


Still, many people expect an antibiotic when they go to their doctor with a respiratory infection (and many doctors continue to prescribe them).



Maryn McKenna has more on the public’s often errant perception of proper antibiotic use, and on highly divergent physician prescribing habits across the country. Follow the link to read:


The Persistence of Resistance And Some Reasons Why

  • By Maryn McKenna
  • November 13, 2012 |  



The `go to’ person on all things antibiotic resistant in the blogosphere is undoubtedly Maryn McKenna, author of Superbug: The Fatal Menace of MRSA and editor of the Superbug Blog. Both of which I highly recommend.


I, on occasion, do wade into the shallower depths of the antimicrobial pool in this blog. A few recent examples include:


EID Journal: Challenges To Defining TDR-TB
India: Still Looking For A Policy On Antibiotics
MMWR: NDM-1 Transmission In Rhode Island
ECDC Response Plan To Multi-Drug Resistant Gonorrhea
CDC Grand Rounds: Multidrug-Resistant Gonorrhea



The problems of antimicrobial resistance go far beyond the overuse, or misuse of antibiotics by the American public. Other threats include:




It will take a multi-pronged, international effort to slow the growth of antibiotic resistance. Agencies like the FDA, CDC, WHO, and ECDC are working towards finding solutions, but there are many competing interests and much bureaucratic red tape.


Progress is often slow. 


Other than supporting the wise use of antibiotics internationally, admittedly as individuals we can’t do much about the use of antibiotics in India, or on the farm, or sold over the internet.


But we can be smart about how we use these drugs. Part of the solution is not being part of the problem.


We either exercise proper stewardship over the remaining drugs we have (and hope that new ones can be developed) or we face a very grim future where minor infections - once easily defeated -  will once again claim millions of lives.

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