Physicians and scientists have been warning of the relentless rise in the numbers of antibiotic resistant bacteria for half a century. But while dozens of reports and recommendations, including by the World Health Organization, have been published on the issue, there has been a noticeable absence of political will, which in turn has meant the public has remained largely unaware of the problem.
— Tracey Guise, CEO of the British Society for Antimicrobial Chemotherapy. Laura Piddock, Director of Antibiotic Action. 2014.

Synopsis

The problem of antibiotic resistance has become particularly dire over the last decade. In the USA and around the world, physicians and scientists have been sounding the alarm about the rapid spread of germs, like CRE, that are resistant to all or virtually all antibiotics. In late 2014, President Obama warned that antibiotic resistance is a threat to public health and national security and signed an executive order to combat the menace that includes the creation of a task force to be co-chaired by the Secretaries of Health & Human Services, Agriculture, and Defense. In a 2014 report that was commissioned by the UK Prime Minster David Cameron, worldwide antibiotic resistant infections were projected to lead to at least 10 million extra deaths per year and costs of up to $100 trillion by 2050. While such long-term projections are subject to a high degree of uncertainty, these estimates underscore the enormity of the problem.

It is imperative that we understand that antibiotics are a limited common resource that we must conserve. Every time an antibiotic is used, it tends to select for resistance by killing all but the most hardy germs. The surviving germs have mutations in their DNA that confer resistance. These mutations arise naturally as the germs reproduce because DNA replication is not without error. The germs can spread their resistance by copying and transferring their DNA to other germs in a process called lateral gene transfer. As the resistance spreads, the utility of the antibiotic diminishes, sometimes to a point where the antibiotic becomes useless. At the same time, the development of new antibiotics is becoming ever more difficult, in part because we have already developed the easier-to-discover antibiotics. That is, screens for new antibiotics often just turn up old antibiotics, and this is happening with increasing frequency. Therefore, we must always be cognizant of the danger that we could run out of useful antibiotics. The inappropriate use of antibiotics by one group of people needlessly promotes resistance and so poses an unnecessary risk to all of us. It is our collective moral responsibility to conserve antibiotics by using them only when necessary to treat infections. In 1945, the discoverer of penicillin, Alexander Fleming, recognized this when he said: "The microbes are educated to resist penicillin and a host of penicillin-fast organisms is bred out. ... In such cases the thoughtless person playing with penicillin is morally responsible for the death of the man who finally succumbs to infection with the penicillin – resistant organism. I hope this evil can be averted."

Yet the overuse of antibiotics in the USA is rampant both in food production and human medicine. Data suggests that 70% of all antibiotics sold are used in food animals, not humans. The same data suggests that the majority of antibiotics used in food animals are administered to compensate for crowded and unsanitary conditions and to speed animal growth. Furthermore, it is estimated that 50% of all antibiotic prescriptions for human use are unnecessary. In many cases, the antibiotic is being prescribed for a viral infection, but antibiotics are not designed for and hence are totally ineffective against viruses. All this misuse of antibiotics selects for resistance among the germs living in and on animals and humans.

One major driver of the overuse of antibiotics is powerful special interest groups who profit from the sales of antibiotics. These groups intensely lobby politicians to maintain the status quo. Currently, there are four bills pending in the US Congress (H.R. 820, S. 895, H.R. 1150, and S. 1256) that are designed to require more detailed reporting about antibiotic use and/or to limit overuse. Unless the American public puts pressure on its politicians, none of these bills may ever even make it to a vote.

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