The Road to a Post Antibiotic Era
By Sarah Baribault / Nursing Major
Since the discovery of the first antibiotic, we have been living in the golden era of miracle drugs. A simple case of strep-throat, a simple cesarean section, or a routine joint replacement surgery are commonly prescribed an antibiotic just in case. However, all of these “just in case” incidences have quickly added up resulting in the crisis of antibiotic resistance. As infections move across the globe, 2 of 100 drugs might work with side effects to cure them (Mckenna, 2015). If we lost antibiotics, we would lose protection for patients with frail immune systems such as babies or cancer patients. We would learn to fear now seemingly minor complications such as skin conditions or the common cold like we used to in the pre-antibiotic era. “Indeed, we are further away than ever from ‘closing the book on infectious diseases,’ which despite the availability of antibiotics, remain the second leading cause of death worldwide and the third leading cause of death in the United States” (Spellberg et al., 2008). Despite this trend, drug development has decreased significantly within the last decade for many reasons. Thus, the co-occurring issue of increasing antibiotic resistance and decreasing drug development challenges patients, healthcare systems, and scientists worldwide.
Antibiotic resistance is building the road to a post-antibiotic era rather quickly. One of the main factors is due to the increase of antibiotic resistance. As more antibiotics become resistant, a greater variety of drugs need to be available to attempt to treat the same disease from different angles. However, the process to creating these new drugs is expensive, high-risk, and time extensive. Research shows that high attrition rates and increased clinical trial costs are two attributing factors to the high expenses (Elder, Kuentz, Holm, 2016). This leads to the second point as to why drug development has decreased. Our healthcare system is rapidly expanding in the height of costs and the rapid emergence of new diseases. Therefore, the healthcare industry is in dire need of new solutions to reversing antibiotic resistance and increasing drug development.
The co-occurring issue of increasing antibiotic resistance and decreasing drug development challenges patients. Antibiotic resistance has altered the fate of patients with infections. Death and other such complications are more prone to occur. “Patients who don’t receive appropriate treatment promptly are at increased risk for a longer disease course of fatal outcome and remain infectious for longer periods, increasing the likelihood of transmission or the resistant microorganisms if infection control measures aren’t implemented” (Friedman, Temkin & Carmeli, 2016). Often times, patients aren’t knowledgeable about the proper treatment for their ailment, so when they are given pills, the average person is prone to take them without asking questions. Patients are lacking in their knowledge of quality and effect of the antibiotics they are taking, so they can’t make decisions on when and when not to take them (Spellberg et al., 2008). They rely on their own self-medication which is one of the most common reasons for the rapid progress of antibiotic drugs becoming resistant. People desire to play an educated role in treating their own ailments by purchasing drugs over the counter, so they can avoid the expensive healthcare system. There is greater chance people will choose to take a higher dosage of drugs than a lower dosage. As a result, patients will be in hopes that their recovery time will be quicker. “Wastage of economic resources and serious health hazards including prolonged illnesses and adverse reactions are few of the many problems that are related to self-medication” (Rather, Kim, Bajpai & Park, 2017). Infected patients that have diseases may need to undergo surgery to remove the infection. However, infections that aren’t able to be removed surgically have high mortality rates (Friedman, Temkin & Carmeli, 2016). Increased mortality rates and premature death will incur a significant financial burden upon patients and the healthcare system. This problem has spiraled into a severe health crisis affecting patients across the globe. The lack of patient knowledge leads to unnecessary prolonged illness and a possibility of additional surgeries, thus increasing pressure on the healthcare system.
The extensiveness of resistance has consequences in regards to both prescribing policies and recommendations for antibiotics.
The co-occurring issue of increasing antibiotic resistance and decreasing drug development challenges healthcare systems. “Resistance, as a whole, increases the number of infections that occur, the cost, delayed hospital productivity, and restriction of treatment opportunities. Increasing antibiotic resistance potential threatens the safety and efficacy of surgical procedures and therapies” (Friedman, Temkin & Carmeli, 2016). The extensiveness of resistance has consequences in regards to both prescribing policies and recommendations for antibiotics. These consequences delay hospital productivity. Due to the large amount of drugs that are resistant, there are less and less alternative drug options to be prescribed. Therefore, lack of antibiotic drug options has a negative affect on hospitals and clinics. There are less life-saving options to be utilized when necessary. Consequentially, the number of opportunities for beneficial treatment decreases. If a patient elects to have a surgery, but contracts an infection post-operatively, chances of adverse effects to the patients in the surrounding beds increases. Nosocomial outbreaks are among the worst situations hospitals have to control. “As of the year 2000, the CDC reported that ∼70,000 deaths due to nosocomially acquired, drug-resistant infections occurred per year in hospitals throughout the United States” (Spellberg et al. 2008). Additionally, this infection may spread to the healthcare personnel on the case. On a day-to-day basis, hospitals sometimes decide on complete closure of a contaminated unit in order to control the nosocomial outbreak. This is an expensive option and has an enormous impact on daily hospital activity. The United States alone spends $20 billion dollars a year on treatments of antibiotic resistance infections. Developing countries, where the healthcare systems are not as advanced, also report comparatively high costs. (Rather, Kim, Bajpai, & Park, 2017). This situation presents a major global public health concern. In response, scientists have recently begun to scratch the surface of next-generation sequencing platforms. These platforms include whole-genome sequencing to detect the virulence of resistant antibiotic genes (Frieri, Kumar & Boutin, 2017). This allows scientists to dig deeper and reverse resistance at the gene level. This way, it will offer the opportunity to keep drugs that will not benefit certain populations out of reach.
Physicians are commonly blamed for this problem of antibiotic resistance because they misuse and over-prescribe drugs. However, this belief is false and reflects our misunderstanding of the incredible capabilities of the microbe (Spellberg et al., 2008). Recently, the common trend of ‘Rx-to-OTC’ has become more popular. This trend is when prescription medicines, after an extensive period of time, switch to over the counter status (Rather, Kim, Bajpai & Park, 2017). The common thought is that patients are now educated and capable of taking these drugs without physician’s instruction. Unfortunately, this rampant drug use increases the expenses for patients because they have to purchase them more frequently. This trend will most likely increase pressure on the healthcare system as more patients overuse these medications and become resistant to them. To eliminate this expanding global crisis, it is necessary that the government involve themselves to create regulatory standards and necessary healthcare policies. If we inform patients to use antibiotics correctly, it will not only decrease microbial resistance, but increase the amount of time for scientists to solve this problem.
The co-occurring issue of increasing antibiotics and decreasing drug development challenges scientists. In the last ten years, the cost of developing new drugs has more than doubled (Elder, Kuentz & Holm, 2016). This was due to heightened attrition rates and the increase of clinical trials costs. The lack of new drug development by the pharmaceutical industry, due to reduced economic incentives and challenging regulatory requirements, is strongly linked to the antibiotic resistance crisis (Ventola, 2015). Creating a new drug is a strenuous, expensive process. Research has shown (Spellberg et al., 2008), given the high costs required for production, drug development is currently estimated to be $400–$800 million per approved agent. Costs of development have more than doubled in the last ten years. According to PhD Daria Mochly-Rosen (James, 2010), drug development is both time consuming and costly. Initially, the diseases’ molecular basis must be identified in accordance with finding a molecular target and to ensure the absence of unwanted outcomes. Then, pre-clinically, scientists test the drug in animals to ensure it is effective on a similar human diseases without side effects. Lastly, the drug must pass three phases of clinical trials. It is extremely possible the drug may fail at any phase of production (James, 2010). From the year 1983 to 2007, the FDA implemented a reduction in the number of approved antibiotics. The difficulties that existed between the pharmaceutical companies and FDA approval included “bureaucracy, absence of clarity, differences in clinical trial requirements among countries, changes in regulatory and licensing rules, and ineffective channels of communication” (Ventola, 2015). Antibiotics are short-course therapies and therefore yield a lower rate of return. However, drugs prescribed for chronic conditions are more profitable, so pharmaceutical companies prefer to invest in them instead. This way, they are still attributing to the development of drugs and not wasting time and money all together. Pharmaceutical companies have refocused their development efforts on other issues, at the expense of antibiotic drug development. According to research (Ventola, 2015), fifteen of the eighteen largest pharmaceutical companies chose to abandon the antibiotic industry. New antibiotics are treated as “last-line” drugs because physicians choose to use their old, more well known prescriptions before recommending the new ones. On one condition, it is necessary that new drugs are developed to overcome the challenge of resistance. However, from the opposing viewpoint, some people believe that it is necessary we minimize the occasions in which antibiotics are prescribed. It’s possible to argue that antibiotics are not the “cure-all” to antibiotic infections. Rather, they recommend that patients utilize alternative methods instead of medication. These alternative methods may include usage of essential oils or botanicals. Our globe is in need of a solution to this ever-growing issue. Cutting edge science is needed to trigger the development of new antibiotics.
If no effort is made to reverse this issue, our society will continue to drift toward a “post-antibiotic” era. Microbes continue to increase in resistance, the pharmaceutical industry continues to decrease productivity, and the majority of people across the globe remain unaware of this crisis. In some cases, people disagree with prescribing antibiotics altogether. They believe that illness can be fought without the usage of antibiotics. Neither opinion is more correct than the other, but the latter opinion would aid in the fight to eliminate antibiotic resistance. This viewpoint offers a second solution. Within the last decade, the development of botanicals to combat antibiotic resistance has become a more common trend. Botanicals may propose a solution to the issue as they use their abilities to not only by destroy the microorganism, but also affect the pathogenic process. Therefore, viruses and fungi have a decreased ability to develop resistance to botanicals (Gupta & Birdi, 2017). Bacteria do not hold the ability to develop resistance to complex chemicals that exist in plant extracts. Scientists are exploring botanicals as an alternative solution. It is possible that physicians and the greater medical system as a whole may turn down this idea at first glance. However, may be beneficial to our world to dig back into the roots of decades past and learn how to cure infections with plant-based treatments. If no action is taken to reverse this growing dilemma, it is proposed that, by 2050, 10 million deaths per year will occur globally. Resistant antibiotics and lack of drug development has and will continue to challenge patients, healthcare systems, and scientists all around the world. In the near future, the healthcare system needs to educate the common society as to how large of an issue this is. With further education, the patient population will learn to reduce their self-medication trends. The healthcare system will learn to prescribe fewer antibiotics and only when absolutely necessary and ensure more strict sterile precautions; this will decrease wastage and nosocomial outbreaks. Lastly, the scientist population may spark an interest to begin the development of new, ground breaking antibiotic treatments. In order to eliminate this crisis, all groups involved must work together. Our world is quickly approaching the edge of disaster and do not have that much time to undo the monster we have created.
Works Cited
Elder, D.P., Kuentz, M., & Holm, R. (2016). Antibiotic Resistance: The Need for a Global Strategy. Journal of Pharmaceutical Sciences, 105. Retrieved from https://www-sciencedirect-com.ezproxy. bethel.edu/science/article/pii/S002235491641470X
Friedman, N.D., Temkin, E., & Carmeli, Y. (2016). The negative impact of antibiotic resistance. Clinical Microbiology and Infection, 22. Retrieved from https://www-sciencedirect-com.ezproxy.bethel.edu/science/article/pii/S1198743X15010289
Frieri, M., Kumar, K. & Boutin, A. (2017). Antibiotic resistance. Journal of Infection and Public Health, 10. Retrieved from https://www-sciencedirect-com.ezproxy.bethel.edu/science/ article/pii/S1876034116301277
Gupta, P.D., & Birdi, T.J. (2017). Development of botanicals to combat antibiotic resistance. Journal of Ayurveda and Integrative Medicine, 8. Retrieved from https://www-sciencedirect-com.ezproxy.bethel.edu/science/article/pii/S097594761630448X
James, J. (2010). Why Drug Development is Time Consuming and Expensive. SCOPE: Published by Stanford Medicine. Retrieved from: https://scopeblog.stanford.edu/ 2010/07/21/mochly_rosen_lecture/
McKenna, M. (2015). What do we do when antibiotics don’t work anymore? TED. Retrievedfrom https://www.ted.com/talks/maryn_mckenna_what_do_we_do_when_antibiotics_don_t_work_any_more/discussion
Rather, I.A., Kim, B.C., Bajpai, V.K., & Park, Y.A., (2017). Self-medication and antibiotic resistance: Crisis, current challenges, and prevention. Saudi Journal of Biological Sciences, 24. Retrieved from https://www-sciencedirect-com.ezproxy.bethel.edu/science/article/pii/S131956X17300049
Spellberg, B., Guidos, R., Gilbert, D., Bradley, J., Boucher, H.W., Scheld, W.M., Bartlett, J.G., Edwards, J. (2008). The Epidemic of Antibiotic Resistant-Infections: A Call to Action for the Medical Community from the Infectious Diseases Society of America. Clinical Infectious Diseases, 46. Retrieved from https://academic.oup.com/cid/article/46/2/155/452327
Ventola, C.L. (2015). The Antibiotic Resistance Crisis. Part 1: Causes and Threats. Pharmacy and Therapeutics, 40. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4378521/
ABOUT THE AUTHOR
Sarah Baribault, a freshman at Bethel University from Edina, MN, is pursuing a major in Nursing. She would like to be a Neonatal nurse in a Children’s Hospital one day. Visiting the ocean, reading a good book, and enjoying coffee shop dates on a cool fall morning are a few of her favorite things.
