Back in 1999, infectious disease specialists were worried. Antibiotics, the most important medical development of the 20th century, were losing their power to combat dangerous bacteria, and few new drugs were in development.
As a British medical report noted at the time: “In the closing years of the century, there is an uneasy sense that micro-organisms are 'getting ahead' and that therapeutic options are narrowing."
Today, infectious disease specialists are no longer uneasy. They’re panicked.
Overuse of antibiotics has unleashed “superbugs,” harmful bacterial strains resistant to the drugs that revolutionized medicine in the 1940s.
In the United States, more than 2 million people are infected by drug-resistant bugs each year, and 23,000 die of their infections, according to the U.S. Centers for Disease Control and Prevention (CDC). Globally, drug-resistant bacteria cause an estimated 700,000 deaths annually and are on pace to kill 10 million people a year by 2050 — more than currently die from cancer.
“If we are not careful,” a CDC official cautioned, “the medicine chest will be empty when we go there to look for a lifesaving antibiotic for somebody who has a deadly infection.”
The situation is so dire that the World Health Organization (WHO) has issued its first list of “priority pathogens”— bacteria with such severe antibiotic resistance they’re considered urgent threats to human health. WHO is imploring governments and pharmaceutical companies to accelerate development of new antibiotics.
“The pipeline is practically dry," said a WHO official upon release of the report. Companies have little incentive to invest in drugs that can take a decade to develop and are usually used as short-term treatment.
Meanwhile, as drug companies dawdle, superbugs proliferate.
A study of 48 children’s hospitals, for example, tracked infections of enterobacteriaceae, a family of bacteria that includes salmonella and E. coli, and found the percentage of cases resistant to multiple antibiotics increased 7-fold from 2007 to 2015, a finding the lead author called “ominous.”
In the study, children with resistant strains of the bacteria remained hospitalized, on average, for four more days than the children with more easily treated infections. Enterobacteriaceae, on the WHO’s list of priority pathogens, are responsible for many serious, sometimes fatal, infections that arise in hospitals and nursing homes.
Worldwide, infections once easily treated with penicillin, like tuberculosis, now require rounds and rounds of multiple antibiotics. Treating a drug-resistant strain of TB can now require 14,000 pills, take up to two years to treat, and cost nearly 30 times more than TB that responds to conventional antibiotics.
It is estimated that 70 percent of bacteria around the world have already developed resistance to antibiotics.
What happens when the first-line and second-line antibiotics fail? Minor infections can become deadly, and doctors resort to using drugs previously shelved because they were considered too toxic.
At some point, for some infections, we may be left without any drugs at all.
In 2015, Canadian researchers found, the only remaining oral drug used for gonorrhea treatment failed in 6.7 percent of the patients at a Toronto clinic. Doctors now have just one effective treatment left: an injectable antibiotic called ceftriaxone.
And in 2016, for the first time, an American patient was infected with a strain of E. coli resistant to one of the “last resort” antibiotics, colistin, a drug that lost favor in the 1970s because of its harsh side effects, including respiratory distress and kidney damage.
The patient recovered after being treated by a different drug, but health officials fear this incident is a bad omen. “It is the end of the road for antibiotics unless we act urgently,” a CDC official said at the time.
The Dawn of the Superbug Era
Historically speaking, the rise and fall of antibiotics has happened in a blip. Penicillin, the first antibiotic, began production on a large scale in 1940s. Discovery of new antibiotics peaked in the 1950s and 60s, but no new class has been developed since 1984.
“If antibiotics were telephones, we would still be calling each other using clunky rotary dials and copper lines,” quipped one microbiologist.
These old-school drugs worked well — until they didn’t. The dawn of the superbug era can be traced largely to overuse of antibiotics.
Antibiotics are worthless against viral infections like the common cold, flu, bronchitis, many sinus infections, and most sore throats, yet patients routinely exit the doctor’s office with an antibiotic prescription in hand.
Each year, more than 30% of U.S. oral antibiotic prescriptions — including half of all prescriptions for acute respiratory conditions — are unwarranted, according to a study published in the Journal of the American Medical Association.
Consider the sore throat: Only about 18 percent of adults who show up at the doctor with a sore throat test positive for strep and actually need antibiotics. Yet, the JAMA study found, 72 percent of sore-throat patients are prescribed these drugs.
What’s the harm beyond wasted money?
Well, the unwarranted antibiotic, while doing zilch to fight the virus, will destroy some of the “good,” infection-fighting bacteria in the body. At the same time, other bacteria will outwit the drug and multiply. Over time, these drug-resistant bacteria will spread to others. That’s just one of the many ways bacteria can become resistant to antibiotics.
Also fueling the superbug crisis: the common practice of giving antibiotics to livestock to make them grow faster and stay healthy in their overcrowded facilities. This practice accounts for 80 percent of antibiotic use in the U.S.
It is imperative that these trends be reversed. Otherwise, as the director general of WHO cautioned, “a common disease like gonorrhea may become untreatable. Doctors facing patients will have to say, ‘I’m sorry - there’s nothing I can do for you.’”