Are humans on the precipice of a post-antibiotics era? People rely on antibiotics to cure a host of infections that used to be deadly. However, fatal bacteria are making a comeback in the form of super-bugs; bacteria populations that have developed a resistance to common antibiotics. Without drastic measures to curb the use of current antibiotics and ramp up production of stronger medicines, people may once again be susceptible to these single-celled killers.
President Obama issued an executive order on Sept. 18, 2014 which created a task force to confront the issues of drug-resistant bacteria, lack of new antibiotics, and the overuse of antibiotics at large-scale farms. All three avenues of attack are necessary so that humans continue to prevail over bacteria which can adapt and reproduce quickly.
Every time a population of bacteria is exposed to antibiotics there is a chance that some will survive. These bacteria may have a mutation that renders them resistant to that particular antibiotic. Although most of the bacteria will be killed, the one or two that live can reproduce rapidly and pass on the mutation to their offspring. People actually speed up natural selection by using antibiotics because they kill susceptible microbes and allow resistant bacteria to reproduce sans competition. Soon an entire population of bacteria exists that cannot be destroyed by common antibiotics.
Fortunately, many different types of antibiotics exist for doctors to choose from. When one drug does not work, physicians reach for another in their arsenal. However, the choices are limited and, due to over-prescription, the bacteria populations are developing resistance faster than biochemical engineers can develop new antibiotics. Some medical experts fear that people may reach a point where most antibiotics are useless against bacteria and not enough new antibiotics exist to combat the deadly strains.
The first problem is that people use antibiotics much more often than they should. Modern antibiotics were only created in the 1940s. Sir Alexander Fleming experimented with penicillin in 1928 but it was not produced in a useful form until 1945. Penicillin was soon joined by other natural and synthetic antibiotics as doctors and chemists battled previously incurable infections. Considered a miracle drug, antibiotics were treated as a panacea for all ills. As soon as a patient ran a fever or presented with a sore throat the drugs were prescribed. The past two decades have seen more awareness about drug-resistant bacteria but too many patients and doctors still rely on antibiotics. In addition, people have surrounded themselves with antibacterial products such as soaps, cleansers and sanitizing gels. All these work to naturally select the bacteria that have a resistance and allow them to propagate.
Humans are inventive and innovative. Certainly chemists can continuously create new antibiotics, but there are two obstacles to simply manufacturing unique drugs. It takes time to construct and test a new antibiotic. Most patients infected with resistant bacteria are very ill and need help immediately. Companies cannot fabricate a new drug instantly. More importantly, manufacturing antibiotics is not a profitable business so drug companies are reluctant to invest too many resources into research and development. Antibiotics are relatively inexpensive and used for a short period so constant development of new drugs is not cost-effective. If supply of novel drugs cannot meet the need for them, humans could be on the precipice of a post-antibiotics era.
Obama’s task force will look into ways to address all these issues. The U.S. Food and Drug Administration, the U.S. Department of Agriculture, the National Science Foundation, the U.S. Department of Security and the National Institute for Mathematical and Biological Synthesis will work together to form a plan of action by Feb. 15, 2015. In addition, the government will increase spending on research and tracking drug-resistant bacteria to $900 million and invest $800 million in development of commercial antibiotics. Also, a prize of $20 million will be awarded by the White House for a plan to increase the effectiveness of rapid point-of-care diagnostic tests which identify infections of resistant populations of bacteria. “This represents a major elevation of the issue – a major upgrading of the administration’s efforts to help address it,” stated Eric Lander, co-chair of the President’s Council of Advisers on Science and Technology (PCAST.)
On the other hand, the executive order disappointed many who see industrial agriculture as the root of the problem. The 78 page PCAST report looked at ways to reduce the use of antibiotics in animals grown for consumption, but it fell short of expectations. The FDA will depend on voluntary curtailment of antibiotic use by large-scale farms. It will also rely on voluntary compliance by drug companies to change labeling on antibiotics so they do not claim to promote animal growth. The Netherlands tried to reduce antibiotic use by focusing on growth and oversight, but did not see any results until it banned using antibiotics for disease prevention.
Antibiotics are delivered on a regular basis to healthy animals to prevent possible bacterial infections. Although this makes financial sense for the farmer, as explained above, it speeds natural selection and creates super-bugs. Most commercial farms try to avoid use of human-relevant antibiotics and stick to drugs specifically designed for their animals – but there is no tracking or regulation. The antibiotics are used in the low-level doses that make it particularly easy for resistant bacteria to populate. Senator Kirsten Gillibrand, (D-NY) plans to introduce legislation allowing the FDA to collect data on “farm-level antibiotic use.” Rep. Louise Slaughter, (D-NY) is once more urging Congress to take up legislation she introduced in Feb. 2013 that would require the FDA, livestock producers and drug makers release more data on antibiotic use in food animals. So far, Congress has been slow to act.
By keeping animals slated for consumption healthy, farmers are putting the health of people at risk. An estimated two million infections and 23,000 deaths are contributed to super-bugs in the United States each year. Dr. Barbara Murray, president of the Infectious Diseases Society of America, has testified that humans may, indeed, be at a point in time where no longer will be able to use antibiotics. President Obama is taking the threat seriously and has acted to change course before antibiotics become obsolete.
The White House blog acknowledges that no victory over microbial pathogens can be permanent. The essence of evolution guarantees the populations will adapt and become resistant to human medicines. There is some hope for bacteriophages, viruses that infect bacteria, but that research is still a long way from being useful. The White House blog asserts that it is important to find ways to ensure safe antibiotics will be available now and in the future. If not, humans may be on the precipice of a post-antibiotics era and looking at a long fall backwards to incurable bacterial infections.
By: Rebecca Savastio