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We Are Risking a Return to the Pre-Antibiotic Era

Cancer, diabetes, traffic deaths–these are some of the things that come to mind when you think of the major causes of death. However, many recent reports point to the rise of antibiotic-resistant microbes as one of the greatest public health threats today–see the World Health Organization, U.S. Center for Disease Control, and U.K. Department of Health–with some estimating that by 2050, it could be the leading cause of death globally.

Currently in the U.S. and Europe alone, there are approximately 50,000 deaths each year due to antibiotic-resistant microbes. The costs are staggering in the U.S., estimated at $20 billion in direct costs and another $35 billion in loss of productivity according to the CDC.

So what is it, and where does it come from? Antibiotic resistance is simply the ability of a microbe to survive exposure to a drug that would typically kill it. Bacteria have been fending off antibiotics long before the discovery of the first antibiotics in 1928. Unfortunately for us, there are many of them and they have clever ways of rapidly adapting to acquire and exchange resistances.

Since the problem has been around so long, why is it getting worse? Every time we use antibiotics, we kill off the bacteria susceptible to them, leaving only those who are resistant. Although an individual may never see an infection from one of these resistant strains, they are in circulation and frequently exchange this resistance with other microbes, increasing the likelihood that another infection will be resistant–and therein lies the problem.

Although proper use of antibiotics is a contributor, many experts cite the widespread misuse of antibiotics in the clinic–estimated at approximately 50% of uses–either through taking antibiotics for an infection it is not beneficial for, or failing to take the complete prescription. Additionally, approximately 80% of antibiotics sold in the U.S. are used in agriculture, and in this setting used most frequently to promote animal growth.

This widespread use of antibiotics has led to the proliferation of multi-drug resistant bacteria. In January, a woman in Nevada died from the first documented pan-resistant–resistant to all antibiotics–infection in the U.S.

So, what now? The problem is clear, but the solutions are not. Responsible use is the first step. In clinical settings we need to avoid using antibiotics for non-microbial infections, and as consumers, we must be diligent in using prescriptions correctly. In agriculture, we should stop using them to promote growth, and limit their use to the treatment of microbial infections.

However, even these steps will not be enough. Currently, pharmaceutical companies are developing relatively few antibiotics and alternative therapies as they are not lucrative products. If the economics won’t drive development, then we need governments and NGOs to step up in support of the development of new treatments. If there isn’t a concerted global effort soon, we risk following the current trajectory back to the pre-antibiotic era.

Ryan Botts, Ph.D. is an associate professor of mathematics at PLNU.

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