The Miracle Era of Antibiotics: Are we heading towards doom?

Author Bio: Mitali Adlakha is a fifth-year PhD candidate at UConn Health. She is currently doing her research on Herpes Simplex Virus and its interactions with the host. She hopes to work in the drug and vaccine development for viral infections in the future. She is interested in science communication and educating people about pathogens.

Alexander Fleming, the man who discovered the first antibiotic, speaking in his noble prize winning speech in 1945 said “Then there is the danger that the ignorant man may easily underdose himself and by exposing his microbes to non-lethal quantities of the drug, make them resistant.” Predicted by Fleming 70 years ago, is the miracle era of antibiotics coming to an inevitable end? Are you ready for a world without antibiotics?

Picture: Tracy Hampton, Medical news and perspectives, JAMA 2013

Antibiotics, often called antibacterials, are drugs that kill or inhibit the growth of bacteria. Antibiotics are prescribed by your doctor to treat any infection ranging from sore throat to urinary tract infections. Antibiotics are effective against most bacteria, certain fungus and protozoans. Different classes of antibiotics such as tetracyclines, erthromycins, carbapenems target different types of bacteria. However, antibiotics do no work for viral infections such as common cold and some respiratory tract infections.

The discovery of antibiotics has been the most transformational discoveries of medicine. Infections are something that we struggled to treat for centuries and constituted a major cause of death before the advent of antibiotics. The overall mortality rate from infectious diseases in the US fell by 75% over the first 15 years following the discovery of antibiotics (1).

In the pre-antibiotic era, Strep throat was at times a fatal disease, and ear infections sometimes spread from the ear to the brain, causing severe problems. Other serious infections, from tuberculosis to pneumonia to whooping cough, were caused by aggressive bacteria that reproduced with extraordinary speed and led to serious illness and sometimes death. As newer antibiotics got discovered over the years, scientists hailed the end of infectious diseases. Researchers estimate that antibiotics have increased our lifespan by 2 to 10 years by enabling us to fight deadly infections (2).
They really are miracle drugs, and not only have they saved the lives of millions and millions of people, and changed medicine but antibiotics have also been heavily used in agriculture and livestock. Of the antibiotics produced every year in the U.S, approximately 80% by weight are consumed in the agriculture sector. Antibiotics are fed to animals to increase the efficiency of their digestion, protect them from diseases and also sprayed on fruit trees.
The success of antibiotics has been impressive. At the same time, however, enthusiasm about them has been tempered by a phenomenon called antibiotic resistance. This is a problem that surfaced not long after the introduction of penicillin and now threatens the usefulness of these important medicines. As a biologist, Fleming knew that evolution was inevitable: sooner or later, bacteria would develop defenses against antibiotics.

Antibiotic resistance is a common problem. It occurs when bacteria in your body change, making it difficult for the antibiotics to fight the bacteria. This can happen when bacteria are repeatedly exposed to the same antibiotics or it can happen when certain bacteria are left in your body. These bacteria multiply and become strong enough to resist the antibiotic in the future. This causes your infection to last longer or get worse.

Fleming’s prediction was correct. Penicillin-resistant staph emerged in 1940, while the drug was still being given to only a few patients. Tetracycline was introduced in 1950, and tetracycline-resistant Shigella emerged in 1959; erythromycin came on the market in 1953, and erythromycin-resistant strep appeared in 1968. As antibiotics became more affordable and their use increased, bacteria developed defenses more quickly.

In January 2017, U.S. Center for disease control and prevention (CDC) released a report on death of a woman in Nevada, USA who died of bacteria that are resistant to every available antibiotic (3). This woman was tested and confirmed for the presence of New Delhi metallo-beta-lactamase-1 (NDM-1). NDM-1 was first isolated from a Swedish patient who had returned from India with a urinary tract infection in 2009 (4). NDM-1 provides resistance to bacteria against all known antibiotics. The emergence of NDM-1 and its new variants are becoming a threat to public health.

Evolution has taught bacteria to fight back. Not only in medicine but drug resistant bacteria are outgrowing in livestock and agriculture. In 2011, a report published by the Food and Drug Administration (FDA) found that 65 percent of chicken breasts and 44 percent of ground beef carried bacteria resistant to most common antibiotics. We are fighting a war against bacterial evolution and unfortunately we are running out of time.

We are at the cusp of a dark future with no effective antibiotics. In just a couple of generations, the miracle medicine will be rendered futile by the rapidly evolving bacteria. Imagine a post-antibiotic era where a simple cut on your finger would leave you fighting for life. In that era, transplant surgery would become virtually impossible thus shaking the bedrock of medicine. We could go back to an age which child birth could become potentially risky again. The post-antibiotic era imperils agriculture as much as medicine.

We are heavily overusing our antibiotics. At least 150 million antibiotic prescriptions are written in the United States each year, many of them for children. According to the CDC, every year two million Americans acquire drug-resistant infections and about 23,000 people die as a direct result of these infections (5). Antibiotic resistance is even more of a threat in developing countries like India and China.

While the scientific community can invariably talk, and analyze about the catastrophe of antibiotic resistance, the average person like you holds the key to preventing the spread and creation of resistance. You as an average person can do a lot more than you think. When you are given an antibiotic, follow your doctor’s directions carefully. Take all the antibiotic medicine that your doctor gives you. Don’t save some of the medicine for the next time you’re sick. If you skip even one or two doses, some bacteria might be left in your body. You may become sick again, and your body may resist future antibiotic treatment.
The prospect of a post-antibiotic era needs to be taken seriously not only by the scientific community but also by all of us together as a society. Staying a step ahead of these nightmare bacteria requires ingenuity and radical change.

References:
1. Armstrong G.L. et. al., Trends in infectious disease mortality in the United States during the 20th century. JAMA 1999. https://www.ncbi.nlm.nih.gov/pubmed/9892452

2. Hollis A. et.al., Preserving Antibiotics, Rationally. NEJM 2013.
http://www.nejm.org/doi/full/10.1056/NEJMp1311479#t=article

3. CDC Morbidity and Mortality Weekly Report. January 2017. Pan-Resistant New Delhi Metallo-Beta-Lactamase-Producing Klebsiella pneumoniae — Washoe County, Nevada, 2016. https://www.cdc.gov/mmwr/volumes/66/wr/mm6601a7.htm?s_cid=mm6601a7_e

4. Yong D. et. al., Characterization of a New Metallo-β-Lactamase Gene, blaNDM-1, and a Novel Erythromycin Esterase Gene Carried on a Unique Genetic Structure in Klebsiella pneumoniae Sequence Type 14 from India. Antimicrobial agents and Chemotherapy 2009. http://aac.asm.org/content/53/12/5046.full?view=long&pmid=19770275

5. CDC. Antibiotic Resistance Threats in the US.
https://www.cdc.gov/features/antibioticresistancethreats/