For once, the headlines about the latest health scare are not hyperbole: The end of the Antibiotics Era may be nigh. Staving it off will require fast and creative thinking not only in medical science, but also in public policy.
Public-health officials were horrified but not surprised to find a Pennsylvania woman who had an infection with the same kind of drug resistance first identified last fall on farms in China. The E. coli found in the woman carried the same genetic mechanism of resistance to colistin – a last-resort antibiotic – which was discovered in Chinese livestock that were routinely fed the drug. And this mechanism is easily spread from one bug to another.
The looming danger is that the gene for colistin resistance will make its way to bacteria already immune to carbapenem, another last-resort drug, creating an invincible “superbug.”
No one yet knows the magnitude of the agricultural threat because too many countries, including the U.S., fail to keep track of the amount and kinds of antibiotics fed to various livestock. This needs to change – and fast. In January, American farms are scheduled to stop feeding antibiotics to animals merely to help them grow. But this is a voluntary program, not a legal ban (as in Europe), and data will be needed to find out if the change makes a difference.
People are fed too many antibiotics, too. A study last month found that, in outpatient settings, about a third of prescriptions are written for conditions the drugs cannot treat. Add to that the frequency with which doctors prescribe broad-spectrum antibiotics because they don’t know which bug is causing a patient’s infection, and you’ve created a perfect environment for bacteria to develop resistance.
Ideally, medical science would maintain a full pipeline of new antibiotics to keep one step ahead of germ evolution. But that’s not the case – in part because antibiotics aren’t a particularly good business. Even more ideal would be to have novel formulations that are sparingly used, so as not to overexpose them to the bacterial resistance machinery.
What’s needed, from an economic standpoint, is a way to “de-link” the revenue from the sales of such drugs – that is, guarantee that drugmakers can get paid for effective new formulations. A British commission on antibiotic resistance has just recommended raising billions of dollars from world governments to make payments of this kind.
Improved medical technology is also necessary, including fast diagnostic tests that would help doctors treat infections more narrowly, as well as vaccines, probiotics and other nontraditional approaches. And if public money is to be spent in support of basic science aimed at discovering new kinds of germ-killing compounds, then drug companies should be prepared to share their proprietary compound libraries.
It’s some comfort to know that the Pennsylvania woman with the colistin-resistant infection has recovered; other drugs did the trick. So antibiotics aren’t quite useless yet. But public-health officials are right to warn that they soon will be – unless humans make a concerted effort to find new ways to fight the bacteria that threaten their existence.