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Why we need to take the warnings of a post-antibiotic world more seriously

Already, more than 2 million Americans each year contract bacterial infections that are resistant to bacteria, and at least 23,000 of them die as a direct result.

CDC director Dr. Thomas Frieden: “If we’re not careful, we will soon be in a post-antibiotic era. For some patients and some microbes, we are already there.”

Earlier this fall, the Centers for Disease Control and Prevention (CDC) released a sobering report about the serious and growing threat of antibiotic-resistant bacteria.

Already, more than 2 million Americans each year contract bacterial infections that are resistant to antibiotics, and at least 23,000 of them die as a direct result of those infections. Many others die from medical conditions that were made more complicated by the bacteria-resistant infections.

Those numbers are only going to increase, the CDC report stressed, as the incidence of these infections spread — and as we run out of drugs to combat them.

When the report was issued, the CDC’s director, Dr. Thomas Frieden, issued this stark warning: “If we’re not careful, we will soon be in a post-antibiotic era. For some patients and some microbes, we are already there.”

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Great Britain’s chief medical officer, Dr. Sally Davies, has been even blunter. She has called the rise in antibiotic-resistant infections “a catastrophic threat” — on par with terrorism and global warming — that could cause the effectiveness of the world’s health systems to slip back by 200 years.

Warnings widely ignored

Yet the seriousness of this threat seems to have not yet registered with most Americans (or Brits), including physicians.

Just last week, the American Academy of Pediatrics released new guidelines that call on pediatricians to prescribe antibiotics only for bacterial infections that have been confirmed with a laboratory test.

You would think all pediatricians would already be doing this. The AAP issued similar recommendations in 2004, but, apparently, most pediatricians have been ignoring them.

As one physician who is obviously frustrated with his colleagues told Newsday reporter Delthia Ricks after the AAP’s new guidelines were released, “Taking antibiotics can sometimes do more harm than good, but there are a lot of doctors who think it’s easier to prescribe an antibiotic and pacify Mom than to do the right thing.”

“Half of all sore throats and earaches are probably viral and not bacterial,” he added, “but it takes a lot more guts not to prescribe an antibiotic than to go ahead and do it.”

It’s not just parents who are demanding — and receiving — unnecessary antibiotics from their physicians. As I reported here in October, a recent study found that although only 10 percent of sore throats are triggered by streptococcus bacteria (the only common cause of sore throat that responds to antibiotics), physicians prescribe antibiotics to 60 percent of the patients who come to their clinic or hospital complaining of a sore throat.

The post-antibiotic world

In a long, fascinating and, yes, disturbing, article published last week on the website Medium, journalist Maryn McKenna (“Superbug: The Fatal Menace of MRSA”) explores what a post-antibiotic world would look like.

The article should be required reading for all of us, but especially for anybody who thinks that antibiotic-resistant infections are a concern only for the elderly or people who are already very sick.

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Such thinking, says McKenna, is very naïve — and dangerous. For once we completely lose antibiotics to advancing drug resistance (“and trust me,” she says, “we’re not far off”), our entire medical system will be forced to re-evaluate almost everything it does.

What does that mean? McKenna explains it in detail in her Medium article, but she also offers this summary on her Superbug blog for Wired magazine:

Here’s what we would lose. Not just the ability to treat infectious disease; that’s obvious. But also: The ability to treat cancer, and to transplant organs, because doing those successfully relies on suppressing the immune system and willingly making ourselves vulnerable to infection. Any treatment that relies on a permanent port into the bloodstream — for instance, kidney dialysis. Any major open-cavity surgery, on the heart, the lungs, the abdomen. Any surgery on a part of the body that already harbors a population of bacteria: the guts, the bladder, the genitals. Implantable devices: new hips, new knees, new heart valves. Cosmetic plastic surgery. Liposuction. Tattoos.

We’d lose the ability to treat people after traumatic accidents, as major as crashing your car and as minor as your kid falling out of a tree. We’d lose the safety of modern childbirth: Before the antibiotic era, 5 women died out of every 1,000 who gave birth. One out of every nine skin infections killed. Three out of every 10 people who got pneumonia died from it.

The impact on our food supply

The loss of effective antibiotics would not just dramatically alter how we treat illness. It would also cause us to lose a good portion of our cheap food supply, as McKenna explains:

Most of the meat we eat in the industrialized world is raised with the routine use of antibiotics, to fatten livestock and protect them from the conditions in which the animals are raised. Without the drugs that keep livestock healthy in concentrated agriculture, we’d lose the ability to raise them that way. Either animals would sicken, or farmers would have to change their raising practices, spending more money when their margins are thin. Either way, meat — and fish and seafood, also raised with abundant antibiotics in the fish farms of Asia — would become much more expensive.

And it wouldn’t be just meat. Antibiotics are used in plant agriculture as well, especially on fruit. Right now, a drug-resistant version of the bacterial disease fire blight is attacking American apple crops. There’s currently one drug left to fight it. And when major crops are lost, the local farm economy goes too.

Again, I recommend that you read McKenna’s article on Medium. It’s strong medicine — but the kind all of us should be taking.