Are We Heading For a "Post-Antibiotic" Apocalypse?
I will never forget the gripping scene from the Planet of the Apes where Charlton Heston sees the torch of the buried Statue of Liberty. Thinking that he had landed on a foreign ape-inhabited planet, he realizes in this final scene of the movie that he has actually returned to Earth after an apocalyptic era of science gone wrong. A recent report issued by the US Center for Disease Control (CDC) warning of a potential "post-antibiotic" era conjured up the image for me in a new light.
The CDC Report
This week, the CDC released what has been called a landmark report on the increasingly lethal threat of antibiotic-resistant bacterial infections. In the report, entitled "Antibiotic Resistance Threats in the United States, 2013," trends are outlined regarding the battle between "bugs and drugs." In other words, the report highlights how infection-causing bacteria are slowly coming to win the battle in outwitting the antibiotics that we use to kill them.
While it's well-known that antibiotic resistance is advancing in other countries, it is also happening in the United States on a grand scale. In the U.S. last year, 2 million people were infected with an antibiotic-resistant bacteria. In 23,000 this infection was fatal. These numbers are rising, giving evidence to the theory that we are presently losing the fight.
Examples of these serious, resistant infections include Clostridium difficile (a secondary intestinal infection), drug resistant gonorrhea (a sexually transmitted disease), drug resistant salmonella (intestinal infection), and methicillin-resistant Staphlococcus aureus (MRSA, which can infect just about anywhere in the body).
Most concerning in the report was the inference that we may have come from a pre-antibiotic era, are presently in an era of antibiotics, and will potentially be moving to a post-antibiotic era in which we have little available to treat many of our body's bacterial invaders.
The Pre-Antibiotic Era
In ages past, life-and-death infections were common place.Large families tended to have at lease some children succumb to fever. Pneumonia was known as "the old man's friend," an easy way to pass on. An infection often meant confinement to bed, sweating it out, hoping and praying that the body's immune system would be enough to fight off the infection.
Medicine had little to offer in those days. Blood letting, leaches, and tonics often caused more harm than good. Death came much easier then when an infection was involved.
The Antibiotic Era
Enter antibiotics in the earlier part of the 20th century. The accidental discovery of penicillin within bread mold by Alexander Flemming is rightfully hailed as one of the greatest chapters in medical history. These drugs were quickly developed and put to common use saving millions of lives. As such, doctors didn't hesitate to use them, even when a bacterial infection was nothing more than a possibility. And why not? What could it harm? Yet, behind the scenes, on the microscopic level, some of the bacteria survived the antibiotic annihilation... better, stronger, faster.
A Post-Antibiotic Era
Could we be heading for a time when antibiotics simply don't work any longer? Will we again be helpless against bacterial infections, sweating out our maladies and relying solely on our immune systems? The trends are a bit concerning. Within the past couple of decades, we have a multitude of new infections with "smart" and resistant bacteria leading to death and wreaking havoc for doctors, hospitals, and institutions. The trend is potentially extremely harmful and relying on science to save us with new antibiotic developments seems risky.
What Can We Do?
At the very least, the trends in antibiotic resistance are a wake up call that we need change or things are going to continue to get worse. Research and development firms are working toward finding better antibiotics that work on those with resistance to the present weaponry.
Most importantly, however, change needs to happen on a more microscopic level - as individual patients and healthcare providers. It's estimated that about 50% of antibiotic prescriptions are taken when there is not an actual bacterial infection present. For instance, a lot of viral respiratory infections are treated with antibiotics. While the virus runs its course, only the body's normal bacteria are wiped out, save those with resistance. Thus, the resistant strains thrive while the weaker strains are killed. Prevention of bacterial infection is also important with common sense measures such as hand washing and isolation to reduce exposure. Lastly, the CDC is also working hard to track patterns of resistance to learn more about our microscopic enemies.
While a full blown antibiotic apocalypse is unlikely, we are seeing some concerning trends in the growing rates of antibiotic resistance. Gone are the days of carte blanche antibiotic use. It's vital that we begin practicing smarter prescribing habits among healthcare providers. As another classic once said, "The times, they are a changing!"
Antibiotic Resistance Threats in the United States, 2013. CDC. Published online September 16, 2013.