For Immediate Release
October 14, 2010

KDHE Office of Communications
communications@kdheks.gov, 785-296-0461

Preventing a Post-Antibiotic Future

An Op-Ed Column by Jason Eberhart-Phillips, MD
Kansas State Health Officer

If you read the accounts of physicians caring for patients in American hospitals before the coming of antibiotics 75 years ago, you will be astonished at how little they could do to fight the ravaging effects of many of the everyday infections they saw.

Without antibiotics, the “miracle drugs” that revolutionized medicine by the middle of the twentieth century, bed rest and good nursing care were just about all that doctors could offer their patients when they showed signs of succumbing to infection.

In those pre-antibiotic times, ordinary wounds or illnesses acquired from contaminated foods, unprotected sex or uncovered coughs would quickly amount to death sentences for tens of thousands of Americans every year. It was a time in humanity’s age-old struggle with the invisible agents of infection when the microbes clearly held the upper hand.

Of course, antibiotics changed all that. But humanity’s struggle against the germs that infect us did not end when these drugs appeared on the scene, and growing resistance to antibiotics in the microbial world today threatens to swing the balance back in the microbes’ favor.

Many experts now warn that we are rapidly heading into a post-antibiotic world, a time when doctors will again stand by their patients’ beds helplessly, unable to treat a host of common infections with more than bed rest and good nursing care, because none of their antibiotics work any longer. In fact, the World Health Organization now calls antibiotic resistance one of the world’s three greatest threats to human health.

Antibiotics work by killing or inhibiting bacteria that are susceptible to them. With frequent use, these drugs exert “selective pressure” on populations of bacteria they encounter, enabling individual bacteria that are intrinsically capable of resisting them to survive and gain a competitive advantage. Over time, excessive or inappropriate use of particular antibiotics can promote the emergence of resistant bacterial strains.

The spread of resistant organisms has already brought the treatment of certain infections to the brink of incurability. Many so-called gram-negative bacteria are now resistant to almost every drug doctors can throw at them, even agents once reserved for “last resort” use because of their cost and toxicity to patients.

Multi-drug resistant tuberculosis has become a global challenge, exceeding 20 percent of cases in certain parts of the world and posing an ongoing risk to the United States. Each drug-resistant case costs 10 to 100 times as much to treat as a drug-susceptible one, and cases of “extreme” drug resistance, where none of the usual combinations of drugs are effective, are increasingly common.

The bacteria that cause gonorrhea, a sexually transmitted infection that is currently on the rise, have become resistant to one antibiotic after another in recent decades. Now only one class of drugs still works, and resistance to these agents is starting to turn up in Asia.

In the past, as resistance to antibiotics developed, other new drugs would come on the market to take their place. This is no longer the case. Antibiotics account for less than two percent of drugs under development by the world’s 15 largest pharmaceutical companies. The pipeline for new drugs to fight gonorrhea and other high-priority infections is almost dry.

Clearly, this means we need to become better stewards of the antibiotics we’ve got. Each of us – whether we are consumers, prescribers or dispensers – must work together to prolong the effectiveness of these amazing agents for as long as possible, as we encourage governments and drug makers to collaborate on ways to address the dearth of new antibiotics under development.

Hospitals and clinics throughout Kansas, as in the rest of the United States, are starting to find ways to reduce unnecessary antibiotic use as part of a comprehensive strategy to lower the risk of healthcare-associated infections. Policy makers in public health, veterinary medicine and agriculture are coming together to discuss how to ensure the appropriate use of antibiotics in animal husbandry.

These are important steps to reduce the risk of antibiotic resistance in Kansas and around the world. As health care consumers we must do our part as well:

  1. Don’t lean on your healthcare provider to prescribe antibiotics for colds and other infections when he or she advises that antibiotics are not necessary.
  2. When antibiotics are prescribed, take them exactly as directed for as long as they were prescribed, even if you are feeling better sooner.
  3. Never share your antibiotics with anyone else.

If we all become good stewards of today’s antibiotic resource, appreciating its value to society and working to protect it for future generations, we can overcome the problem of antibiotic resistance and help humanity regain the upper hand over our microbial foes.

Dr. Eberhart-Phillips is the Kansas State Health Officer and Director of Health in the Kansas Department of Health and Environment. He can be reached at jeberhart-phillips@kdheks.gov. Go to his blog at: www.kdheks.gov/blogs/dr_jasons_blogs.htm.