The end of antibiotics, period?

Submitted by Carlyn Zwarenstein on November 7, 2013 - 22:27

Twenty years ago, I wrote a paper for my high school biology class on the not-much-discussed topic of antibiotic resistance. What I learned seemed like science fiction; due to overuse and improper use of antibiotics, we faced a return to the dark ages before penicillin, when a chance infection could easily spell death and doctors were largely helpless in the face of them.

But after writing my essay, life went on. When I got sick, antibiotics were readily available. I remained wary of antibacterial cleansers and other bacteria-bashing products, but essentially, it seemed that I’d been a bit alarmist.

And yet, over the years, the very real problem of antimicrobial (the more expansive term) resistance has continued to grow. First the problem was largely confined to hospitals where healthcare-associated infections that have become increasingly resistant to the agents commonly used to treat them. More recently, resistance has spread strongly to community settings outside the hospital. This moves us into a new age, similar to the bad old one we’re mostly too young to remember (say, pre-1936 when sulfa drugs were first employed).

As Dr. Arjun Srinivasan of the  Centers for Disease Control and Prevention puts it in a recent PBS doc (here’s the edited transcript), we’re reached “the end of antibiotics, period.” Dr. Srinivasan goes on to mention a few of the less-obvious implications of it becoming increasingly difficult to treat bacterial infections that over the past several decades have been non-issues.

These include loss of the easy treatment of common infections that made organ transplantation feasible of the past several Antibiotic Age decades. They also include the risk of infection to those taking the new, ground-breaking ‘biologic’ drugs that lower the immune system in order to control auto-immune diseases like rheumatoid arthritis and others. As a grateful but anxious user of one such expensive, relatively effective medication, this makes the dangers of antibiotic resistance feel very real to me.

 The website of the Canadian Antimicrobial Resistance Alliance, a Winnipeg-based alliance of infectious disease experts (still listed as an editorial board member is the recently deceased Donald Low of SARS renown), presents information about antimicrobial resistance in Canada and elsewhere for healthcare providers and researchers as well as for media and the lay public (antimicrobial being the more inclusive term, encompassing antifungal, antibacterial and other agents).  You can even view videos showing the mechanism of action and of resistance of different antimicrobials. And I learned about the CANWARD 2007-11 study, which surveyed antimicrobial susceptibility of some 22746 pathogens.

What the study and other resources presented on the site clearly show is that indeed, antimicrobial resistance is an escalating problem—although Canada’s rates look relatively good in the global scheme of things (and the situation in the U.S. is quite as alarming as Dr. Srinivisan says). What we need is public and practitioner education; investment into a coordinated research effort to fine-tune antibiotics, develop new agents and conceive of new ways to combat resistance; vaccination where possible; and antibiotic use that is both carefully targeted and judicious. I highly recommend CARA’s  overview of the situation for the media, which is clear, comprehensive, and informative for any interested reader.

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