Sean Philpott-Jones: The Age Of The Superbug

Sep 22, 2016

With all of the media hullaballoo about Hillary Clinton’s pneumonia, Donald Trump’s physical exam, Brangelina’s impeding divorce, and poisoned Skittles, you may have missed one of the biggest and most important health stories of this year.

Just yesterday, the United Nations General Assembly held a day-long meeting in New York City to discuss one of the most deadly threats to human health since the bubonic plague: antibiotic-resistant bacteria. This is only the fourth time in history that the General Assembly has met to address a health issue, having met twice in 2011 to talk about HIV/AIDS and chronic diseases, respectively, and again in 2014 to discuss the West African Ebola outbreak.

Antibiotic-resistant bacteria pose an even greater threat than Ebola, HIV/AIDS, and heart disease combined. According to the US Centers for Disease Control and Prevention (CDC), antibiotic-resistant forms of common bacteria like E. coli, Staphylococcus aureus, Streptococcus pneumoniae, and Mycobacterium tuberculosis – among others – infect nearly 2 million people a year in the United States, killing at least 25,000.

Worldwide, the number of people infected is several magnitudes greater; an estimated 750,000 people died from antibiotic-resistant infections in 2015. Within just a couple of decades, that number is expected to increase by nearly 1500%, yielding over 10 million “superbug”-related deaths annually by 2050.

Antibiotic-resistant infections will soon account for one-third of all deaths globally, a startling turnabout from 1967. That year, thanks to the widespread use of antibiotics and still effective public immunization programs, then Surgeon General William Stewart famously stated that, “the time has come to close the book on infectious diseases. We have basically wiped out infection in the United States.”

However, it turns out that it was the very successes that Dr. Stewart was touting –including copious use of antibiotics – that resulted in the grave crisis that we face today.  It was the overprescribing and misuse of antibiotics over the past 50 years that allowed these superbugs to emerge.

Commonly used antibiotics like amoxicillin, cephalexin, azithromycin and ciprofloxacin still kill most bacteria, but a small percentage of these microorganisms are naturally resistant. Naturally occurring resistance has been seen for every antibiotic that has ever been developed. Thus, whenever an antibiotic is used, the drug-sensitive bacteria die off but the resistant bacteria survive. Eventually, if a particular antibiotic is used enough, the resistant bacteria take over.  This is why antibiotics should only be used sparingly.

Unfortunately, we haven’t been so thoughtful in our use of these drugs. Ever since the first antibiotics were prescribed to treat serious infections among the soldiers fighting in World War II, we have used them more and more liberally. 

It is not uncommon, for example, for a physician to prescribe an antibiotic like azithromycin to a patient with the flu, even though these drugs do not work on viruses like influenza. They may do so because they are hurried, because they misdiagnosis the illness, because they want to prevent potential secondary infections, or (most likely) because their patients expect them to.

We also use antibiotics for non-medical purposes. Nearly 80% of the antibiotics produced annually in the US are not used to treat infections, but instead are used by farmers as growth promoters. Antibiotics are routinely added to the feed or water of agricultural livestock – cattle, pigs and poultry – in order to make these animals fatter.

Given the high-dosages used, many of these drugs pass through the digestive system un-metabolized and are thus present in animal waste. This waste eventually enters the ecosystem through agricultural run-off or sewage spills, contaminating the ground, local streams and rivers, and underground aquifers. In agriculturally intensive regions of the world, pharmaceutically active concentrations of antibiotics are routinely found in soil and water samples. One study of the Yangtze and Pearl Rivers in China, for example, detected more than 60 different antibiotics in those waterways, often at levels that were 10,000 times greater than the normal human treatment dose.

As a result, the world is quickly running out of effective antibiotics. Despite this, there are few new antibiotic drugs in development. This is not because the need isn’t there, but it is simply too expensive and too difficult for pharmaceutical researcher and drug manufacturers to develop, test and market new antibiotics when the bacteria adapt so quickly.

Unless we change our current practices, we will soon be entering a post-antibiotic era.  We need to stop prescribing antibiotics for every little cold. We need to stop using these drugs to satisfy our desire for cheap meat, milk and eggs. We need a global effort to develop new drugs and treatments for the myriad of drug-resistant bugs we already face. And we need to do it before it is too late.

A public health researcher and ethicist by training, Dr. Sean Philpott-Jones is Director of  Research Ethics for the Bioethics Program of Clarkson University-Icahn School of Medicine at Mount Sinai in Schenectady, New York. He is also Acting Director of  the Center for Bioethics and Clinical Leadership, and Project Director of its Advanced Certificate Program for Research Ethics in Central and Eastern Europe.

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