Few living today can remember a time when millions died each year from pneumonia, cuts, burns and child birth. As recent as the early 1930s, one in 20 infants died before their first birthday. More people died during the influenza epidemic of 1918-1919 than were killed in the four-year-long World War I. All of that changed, as we now know, thanks to an accidental discovery by Alexander Fleming in 1928. Although it took another decade before penicillin was available as a prescribed antibiotic, deaths related to infection immediately began to plummet. In fact, between 1944 and 1972, human life expectancy increased by eight years. But even as doctors and government officials called Fleming’s discovery a “miracle drug” that would forever change the face of medicine, Fleming himself warned against overreliance on antibiotics.
“The greatest possibility of evil in self-medication is the use of too small doses so that instead of clearing up infection the microbes are educated to resist penicillin and a host of penicillin-fast organisms is bred out which can be passed to other individuals and from them to others until they reach someone who gets a septicaemia or pneumonia which penicillin cannot save,” Fleming told the New York Times in 1945.
But, as often is the case in human society, his warnings went unheeded. And now, some 68 years later, the World Health Organization predicts medicine is on the verge of a post-antibiotic era due to the onslaught of resistant microbes.
“Some experts say we are moving back to the pre-antibiotic era. No. This will be a post-antibiotic era. In terms of new replacement antibiotics, the pipeline is virtually dry,” WHO director general Margaret Chan said at a 2012 conference on combating antimicrobial resistance. “A post-antibiotic era means, in effect, an end to modern medicine as we know it. Things as common as strep throat or a child’s scratched knee could once again kill.”
The surge in antibiotic-resistant “super bugs” can be blamed on a variety of factors. Bacteria have been around for more than 3 billion years, and therefore have a keen ability to adapt to environmental changes. Because they often reproduce within minutes, those adaptations occur quickly. Often a patient doesn’t complete his or her full regimen of antibiotics, and therefore not all the bacteria are killed, leaving those remaining able to adapt to the drug prescribed. Likewise, doctors prescribe antibiotics unnecessarily—especially for colds, ear infections and other viral infections—leaving the body susceptible to resistant bacteria. In fact, according to the Center for Disease Control and Prevention estimates, 6 to 8 million unnecessary courses of antibiotics are prescribed each year to treat ear infections alone.
The phenomenon is nothing new. In fact, as early as the 1950s, resistant infections were reported. But during the early days of antibiotics, new drugs were developed frequently to counter any bacterial adaptations. Unfortunately, that’s no longer the case. According to many experts, if drug manufacturers were to invest in new antibiotics, a future infectious catastrophe could be avoided. But they simply aren’t interested.
“Over the past two decades there has been a discovery void around antibiotics, meaning diseases have evolved faster than the drugs to treat them,” England’s chief medical officer Sallie Davies recently said. “Antimicrobial resistance poses a catastrophic threat. If we don’t act now, any one of us could go into hospital in 20 years for minor surgery and die because of an ordinary infection that can’t be treated by antibiotics.”
In fact, the last time a new class of antibiotics was introduced was 1987. That’s 26 years without any new drugs, while 19,000 people are dying each year in the U.S. alone from MRSA—more than HIV and AIDS. Sally says drug companies need encouragement because antibiotics are not profitable to them.
“We haven’t as a society globally incentivized making antibiotics. It’s quite simple—if they make something to treat high blood pressure or diabetes and it works, we will use it on our patients every day,” Sally said. “Whereas antibiotics will only be used for a week or two when they’re needed, and then they have a limited life span because of resistance developing anyway.”
But as we wait for such incentives and developments to take their course, we, as a society, must take action to try and lessen the spread of superbug. Stop demanding antibiotics for every cough and sniffle, and take your full regiment as prescribed when they are needed. Let the doctors be the doctors rather than our personal prescription dispensaries.
“At a time of multiple calamities in the world, we cannot allow the loss of essential antimicrobials, essential cures for many millions of people, to become the next global crisis,” said Chan.