Running Out of Cures
What Would a Post-Antibiotic World Look Like?
Imagine a world in which millions of people die from simple bacterial infections.
That world is not so far away. “Superbugs” that have evolved to withstand many once-powerful antibiotic medications already kill 700,000 people a year globally. And unless we quickly turn the situation around, the death toll from infections that today are curable could rise to 10 million a year by 2050.
This is something I worry about. You should too. And since it’s World Antibiotic Awareness Week, I’m spreading the angst.
For me, the worrying started in earnest earlier this year, after my niece Christine was hospitalized with a serious infection that turned septic. Christine has a disease called juvenile dermatomyositis, which makes her vulnerable to infections when calcium deposits on her body break the skin.
While at work, a large calcium deposit on the back of her leg erupted. Although Christine immediately sought treatment at the emergency room, infection set in overnight. She returned to the hospital in the morning and spent 12 nights there.
She was violently ill, throwing up so frequently and so forcefully that her whole body was wracked with pain. She had fevers and chills, and a migraine headache that lasted for five days. During her hospital stay, she had three procedures to drain the infection in her leg.
The doctors tried several antibiotic medications to combat the infection, but none of them worked — until they turned to vancomycin, which is used to treat complicated skin infections, bloodstream infections, endocarditis, bone and joint infections, and meningitis.
Once Christine started on vancomycin, she quickly improved — even more so after she had her third and final surgical procedure to drain the infection.
Yet, powerful as it is, vancomycin isn’t invincible. In fact, resistance to vancomycin first emerged in the 1980s and has grown. According to the Center for Disease Dynamics, Economics and Policy (CDDEP), vancomycin-resistant intestinal bacteria are present in an estimated 12 percent of all hospital patients in the U.S. and an estimated 28 percent of intensive care patients.
This is not unusual; it’s the trend.
Christine is fine now, and has resumed her normal life, including returning to work.
But the danger will never really be over for her. The calcium deposit on her leg has reformed, and she has others on other parts of her body. These are all potential infection sites.
The reality is that Christine will very likely need powerful antibiotics like vancomycin again — and she’ll need them to work.
All over the world, bacteria are developing new resistance to last-line-of-defense drugs exponentially faster than we can develop new drugs to combat them.
What would a post-antibiotic world look like? Well, people like Christine who have chronic health problems would be very vulnerable — including people with not just rare diseases but common ones like diabetes, heart disease, kidney disease, HIV, and a host of other conditions.
Babies — especially those born prematurely — young children, elderly people, and anyone with a compromised immune system, including cancer patients, would also be in peril.
Invasive surgical procedures — from Caesarean sections to hip and knee replacements to organ transplants — would be impossible.
Everyday life for everyone would be a lot more dangerous. A cut from a rose thorn, a fall from a bicycle, or a scratch from a cat could all prove fatal.
What would a post-antibiotic world look like? Everyday life would be a lot more dangerous. A cut from a rose thorn, a fall from a bicycle, or a scratch from a cat could all prove fatal.
How is this happening? Since the discovery of the first antibiotic 70 years ago, we have squandered these critical resources through inattention and gross mismanagement.
It’s estimated that up to half of antibiotic use in humans is unnecessary. Every time we misuse an antibiotic — to treat a viral infection, for example, or fail to complete the full prescribed course of medication — we contribute to the problem. That means that antibiotics become less effective for everyone.
Bad as it is, our misuse of antibiotics in medicine pales in comparison to how drugs developed to save human lives have been exploited by Big Farming. Nearly 80 percent of the world’s antibiotics are fed to farm animals to fatten them up quicker so that they can turn a profit quicker. In this way, too, big meat producers don’t have to worry about maintaining sanitary environments for food animals, which would cut into their profits.
According to CDDEP, more than 131,000 tons of antibiotics were fed to livestock globally in 2013, mainly for growth promotion. That number is expected to jump to more than 200,000 tons by 2030. The US is the second largest user of antibiotics in food production at 9,476 tons, after China, which fed more than 78,000 tons of antibiotics to livestock in 2013. As things stand, those numbers are set to increase.
A new book, Big Chicken, by public health journalist Maryn McKenna, describes how routine use of antibiotics in farm animals revolutionized meat production while fueling the crisis in antibiotic resistance.
What’s both fascinating and horrifying is that this has been going on for decades, and companies were warned of the dangers from the beginning. McKenna shows how outbreaks of bacterial infections — including ones that killed infants — traced back to slaughterhouses that processed antibiotic-infused meat.
Yet despite the clear links to infection outbreaks and repeated warnings from scientists, this practice has continued — because to end it would cost too many people too much money; never mind about the larger cost to humanity.
So here we are.
Is there hope of preventing a post-antibiotic era? Both CDDEP and McKenna say it’s possible, if we act swiftly and forcefully. Stop using antibiotics in food production; take real steps to reduce meat consumption; follow guidelines for proper use of antibiotics in humans; create a surveillance system for tracking antibiotic resistance spread around the world.
Last year, the United National General Assembly for the first time convened a high-level meeting to address the global threat of antibiotic resistance. That seemed like a good sign. But CDDEP Director Ramanan Laxminarayan says that little progress has been made since then.
If we don’t want the world to run out of cures, we need to act now. Buy antibiotic-free meat (unless, of course, you’re vegetarian, which is even better!). If your supermarket doesn’t stock antibiotic-free meat, ask the store manager to offer it. And don’t demand an antibiotic next time you come down with the flu — it won’t do you any good.
Small acts, yes, but they help. And they add up — especially if you spread the word.
Antibiotics are a critical and endangered resource. It’s up to us to safeguard them so that everyone can get cures in the future.
