Global Antibiotic Resistance, the Medical Community’s Biggest Fear
Nearly 5 million people died from antibiotic-resistant infections in 2019, making it the 3rd leading cause of global deaths and sounding the alarm for medical professionals.
The World Health Organization sounded the alarm in 2014, claiming that we are now in the “post-antibiotic era.” By looking at data from 129 countries, they’ve concluded that the overuse of antibiotics in humans and livestock has made bacteria resistant to common antibiotics, meaning they are ineffective in treating infections. Keiji Fukuda, WHO assistant director for health security, believes that “A post-antibiotic era — in which common infections and minor injuries can kill — far from being an apocalyptic fantasy, is instead a very real possibility for the twenty-first century.”
And recent data shows the situation is even worse than previously thought.
So What is Antibiotic Resistance?
The use of antibiotics goes back to antiquity, when civilizations like Egypt, Greece, and China used the mold growing on bread to spread on their skin to control the spread of bacteria. The modern use of antibiotics, though, exploded when Alexander Fleming extracted penicillin from a species of fungus named penicillium rubens. In the following decades its use grew rapidly, especially on the World War 2 battle fields. At the time, there was only an inkling that such extensive use of penicillin and a host of other antibiotics would cause a problem. Today penicillin and its derivatives are manufactured synthetically, making them widely available on a global scale.
When antibiotics are administered, most of the targeted bacteria are killed, but some have natural resistance. Normally, this isn’t an issue, as this is often enough to control the spread of harmful bacteria. However, the bacteria that live can continue to multiply, and because they have an immunity to a particular antibiotic, the same one can’t be used again. Different antibiotics need to be used, and they too can become ineffective over time. Antibiotic resistance was first identified in 1940, and since then the problem has only grown exponentially. Even Fleming himself gave us a warning in 1945 when he said the “public will demand [the drug and] … then will begin an era … of abuses.”
This problem is compounded by 5 unfortunate realities. First, they are overused. In the US, in 2010 alone, 22 doses of antibiotics were prescribed per person on average. The states with the worst problems were Louisiana, Alabama, Mississippi, Tennessee, Kentucky, Indiana, and West Virginia. But his problem is certainly not limited to the US. Second, is inappropriate prescribing. Some studies found that the prescribed antibiotic therapy was wrong in nearly 50% of US cases. Third, we use antibiotics extensively in livestock. This is meant to keep the animals healthy, but the resistant bacteria is transferred to humans when the animal is consumed. In fact, roughly 80% of antibiotics are used on animals. Fourth, the production of new antibiotics is slowing down. Due to increased regulations and less profit to be made, pharmaceutical companies are turning to other products. Fifth, humans can spread resistant bacteria to each other, especially in areas with poor sanitation.
Because of the above, a survey of infectious-disease specialists found that over 60% had seen an infection that was “pan-resistant” in the last year.
The Problem is Worse Than We Thought
Mohsen Naghavi and his colleagues at the University of Washington recently published the first of it’s kind study on antibiotic resistance in the journal The Lancet. By using systematic literature reviews, scouring hospital records, reviewing surveillance systems, and collecting data from a handful of other sources, the team was able to analyze the medical records of some 471 million patients with antibiotic resistance infections in 204 countries. A study of this size and depth on the subject had never been done before, and its results raise several red flags for how we administer and understand antibiotics.
They found that the area with the highest burden was sub-Saharan Africa 27.3 deaths that are directly attributable to antibiotic resistance per 100,000 and 114.8 deaths that are only associated with antibiotic resistance per 100 000. Coming in 2nd was South Asia, followed by Eastern Europe, and Latin America. The area with the least burden was Australasia with 6.5 direct deaths per 100 000 and 28 associated deaths per 100 000.
The main culprits for these deaths were “lower respiratory and thorax infections, bloodstream infections, and intra-abdominal infections.” Together these were responsible for 78% of deaths associated with antibiotic resistance. Lower respiratory deaths alone were roughly 400,000 in 2019. 6 pathogens were responsible for these deadly infections: “E coli, Staphylococcus aureus, K pneumoniae, S pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa,” listed in order of the amount of deaths caused.
The researchers found that the total death count was nearly 5 million people for just 2019 alone.
So What Are the Solutions?
- Infection Prevention and Control. This includes anything to stop infections from occurring and spreading, as well as stopping the spread of antibiotic resistant bacteria. This can take the form of hospital-based prevention programs, maintaining clean water supplies, educating communities on the best sanitation methods, etc.
- Vaccinations Are Paramount. Vaccines can control infections without the use of antibiotics. However, only 1 of the above 6 pathogens (S pneumoniae) have a vaccine to fight it. Research is being done to develop vaccines for the other 5.
- Stop Using Antibiotics on Livestock. Unless antibiotics are necessary in controlling infections in humans, humans shouldn’t be needlessly exposing themselves to antibiotics.
- Antibiotic Stewardship. This is the idea that doctors, hospitals, care-facilities, etc. should do as much as possible to ensure that antibiotics are administered appropriately.
- The Antibiotic Pipeline. This refers to the beginning-to-end production of antibiotics, which includes both public and private funding/research. The pipeline needs to be active, in that it needs to regularly bring new antibiotics to the market.
All 5 of these need to be accomplished through the coordination of nations, NGOs, companies, and individuals on a global scale. If not, the problem of antibiotic resistance is only going to get worse.
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