A few weeks ago, the Centers for Disease Control and Prevention released a threat report about antibiotic resistance. It gave hard statistics on the damage caused by antibiotic resistance and offered advice to medical professionals about how to prevent the problem from becoming worse. For example, 23,000 people die every year from antibiotic resistant infections, and a number more die from complications after infections. It also discussed various microbes that are developing antibiotic resistance and how much of a threat each one posed. Dr. Tom Frieden warned, “If we are not careful, we will soon be in a post-antibiotic era.”
Antibiotic resistance has been a well-known phenomenon for years, and the problems it could cause have been copiously speculated on in the past. This CDC report confirms the fears and speculations of the scientific community. Something must be done to reduce overuse of antibiotics and search for other ways of treating and preventing bacterial infections.
Bacteria have short generation times, so they evolve quickly. If an antibiotic is used, the few bacteria that remain after treatment will have some degree of resistance to the antibiotic, and they will reproduce and/or give the resistant gene to other bacteria with horizontal gene transfer. After enough antibiotic use in enough people, the mutations that transfer resistance become widespread. Either a higher dose of antibiotics is needed to get rid of the mutated bacteria, or a new antibiotic altogether.
An obvious solution to antibiotic resistance is, “Oh, just make new antibiotics.” First of all, there’s no money in antibiotics. They’re usually only used short-term. Pharmaceutical companies have little incentive to develop new antibiotics. It’s just delaying the inevitable. In a way, antibiotics are non-renewable resources. We can keep making old antibiotics, but the more bacteria that are resistant to them, the less useful they are. We can make new antibiotics, but the more we use them, the more useless they become.
Something to consider are viruses that infect bacteria, or bacteriophages. Since bacteriophages evolve as well, resistance isn’t as much of a problem. Bacteria will become resistant to bacteriophages, but bacteriophages evolve to be better at killing the bacteria. It’s a balanced predator-prey relationship. However, if one was to get enough predators to outnumber the prey — add enough bacteriophages to an infection site to outnumber the bacteria — it could be a very effective treatment. Phages are untapped resources and should be investigated further.
Another paradoxical-sounding way of treating and preventing bacterial infections is by using other bacteria. The gut flora is an ecosystem in its own right. Clostridium difficile, or C. diff, is a bacterial infection of the intestines that usually happens when the gut flora is defective and C. diff has an opportunity to flourish. It has adapted rapidly to antibiotics, and is difficult to get rid of. One treatment that has helped get rid of C. diff is a fecal transplant. It involves taking fecal bacteria from someone with a healthy gut microbiome and inserting it into the intestines of someone with an unhealthy gut microbiome — the good bacteria grow and crowd out the nasty ones. It sounds disgusting, but a recent study in the New England Journal of Medicine reported that C. diff patients had a 94 percent cure rate after a fecal transplant.
It’s not that antibiotics are bad — quite the opposite. Antibiotics are so precious that we can’t afford to waste them on trivial ailments such as ear or sinus infections. Most of those infections are viral, and even bacterial ear or sinus infections will most likely go away on their own in people with a healthy immune system. Antibiotics should be reserved for serious illnesses, where disfigurement or death is a possibility. This will keep them effective for as long as possible. In addition, more research should go into other, more sustainable ways to treat bacterial infections. Antibiotic resistance isn’t something we can just put a Band-Aid on. It’s a serious threat to public health that needs to be addressed as soon as possible.