Superbugs are here, but what can we do about them?
Dr. Mary Anne Jackson recalls the time when, as a young pediatric resident, a mother brought her ill daughter in to see her. The daughter had a viral infection and was on her seventh day of fever, with miserable respiratory symptoms. The infection would go away in time, with plenty of fluids and rest and over-the-counter medication to combat the fever, Jackson advised the mother, who was hoping for antibiotics to cure her suffering daughter.
“Do you have children?” the mother asked Jackson, who at the time did not. The mother told her: “You may want to think about this when you have children.”
The encounter was extremely impactful to Jackson, now the division director of infectious diseases at Children’s Mercy Hospital in Kansas City, who hears daily from parents asking for any and all help in curing their child for fear of losing them.
While she certainly understands parents’ concerns, the staggering truth is that half of all antibiotic use is not necessary, Jackson says. Many people mistakenly think antibiotics help fight viruses, like colds and the flu, when in reality they help combat illnesses caused by bacteria, like whooping cough and strep throat. Improper use of antibiotics can lead to antibiotic — or antimicrobial — resistance, which creates bacteria called superbugs resistant to most antibiotics. Superbugs can be deadly, spread to others and imposes huge costs to individuals and society.
A Crisis Emerges
Considered the first wonder drug when Dr. Alexander Fleming discovered it in a petri dish in 1928, penicillin kept deadly bacterial infections under control, but its widespread use through the 1950s created penicillin-resistant organisms. New antibiotics like methicillin were then developed — some 270 throughout the 1970s — but few currently are in the works. The last wholly new class of antibiotics hasn’t been developed since 1984, according to the November 2016 AARP Bulletin, which also reports that only five of the top 50 big drug companies are developing new antibiotics to combat the growing menace of superbugs primarily because they are not as lucrative as other drugs, such as those to treat arthritis.
Overuse or misuse of antibiotics has become one of today’s most pressing global public health issues, such as methicillin-resistant bugs like MRSA. In many countries, like India and in Eastern Europe and South America, antibiotics are easily available over the counter, and some doctors worldwide needlessly prescribe antibiotics out of habit or to make their patients happy.
“Infections with resistant organisms are difficult to treat, requiring costly and sometimes toxic alternatives,” warns the Centers for Disease Control and Prevention in Atlanta.
The CDC says at least 2 million Americans become infected with bacteria that are resistant to antibiotics, and at least 23,000 people die each year as a direct result of these infections. Moreover, the infections account for at least $20 billion in health care costs and up to $35 billion in lost productivity from hospitalizations and sick days each year. Drug-resistant infections can strike anyone of any age, healthy or sick.
“It truly is a crisis,” Jackson says.
Dr. Mary anne Jackson
What’s Being Done?
Incredibly, between 80 and 90 percent of antibiotics today are given to animals targeted for food consumption, so limiting antibiotic use in agriculture is crucial. To that end, last year McDonald’s stopped using chickens raised with antibiotics and Taco Bell, owned by Yum! Brands, Inc., which also owns KFC, issued a statement committing to stop using antibiotics important to human medicine in its chicken this year.
“This has been long in the making where we put out the message that this has to be curtailed,” Jackson explains. “So what should we focus on? We should focus on less antibiotics in the animals. We should focus on new strategies for the development of antibiotics that may have value against resistant bacteria, and there’s a variety of different directions that that research has taken. Then we have this third part that is this judicious use of antibiotics, reserving antibiotics for when we really need them. And then you have the last part, which is: What are the other things that we can do to prevent the development of resistant bacteria? That’s where vaccines may very well come in.”
Dr. Sarah Boyd, an infectious disease physician with Saint Luke’s Health System and medical director of its antimicrobial stewardship initiative program, points to the Infectious Diseases Society of America’s 10 x ’20 Initiative as a step toward developing new drugs to fight superbugs. The initiative seeks a global commitment to create antibiotic research and development that will produce 10 new systematic antibiotics by the year 2020.
On the governmental front, last year the Obama administration allocated $1.2 billion to fight resistant bacteria, and the United States Department of Health and Human Services selected Boston University to lead a $350 million joint U.S.-U.K. effort to spur the preclinical development of new antibiotics, antimicrobial rapid diagnostics and vaccines. And the National Institutes of Health announced $20 million in awards for researchers who develop new laboratory diagnostic tools to detect and distinguish antibiotic-resistant bacteria.
A growing number of hospitals and other acute-care facilities have implemented antibiotic stewardship programs designed to ensure that patients receive the right dose at the right time and for the right duration. The CDC launched several years ago the Get Smart for Healthcare program aimed at the issue. CMH in 2008 was one of the first U.S. hospitals to implement a stewardship program, Jackson says.
In general, Boyd and Jackson say people would be wise to get smart about antibiotics and become active participants in their health care. As the CDC proclaims: “There are many ways that drug-resistant infections can be prevented: immunization, safe food preparation, handwashing, and using antibiotics as directed and only when necessary.”
The time to go to the doctor if you’re sick, the CDC says, is when you have a temperature higher than 100.4 degrees and your symptoms last more than 10 days and are severe or unusual. For children younger than 3 months old with a fever, your doctor should be called right away. If you get sick with flu symptoms and are at high risk of flu complications or you are concerned about your illness, call your health care provider for advice. For strep throat, tests are required for diagnosis.
Choosing the Right Antibiotic
Judicious use of antibiotics has a simple message at its core: Do not expose an individual to an antibiotic unless they have a bacterial infection for which an antibiotic is indicated. And if one is indicated, use the most narrow-spectrum drug available that aims at a specific infection and administer it for the right duration of therapy. Duration of therapy varies.
“For instance,” Jackson explains, “for uncomplicated ear infections in children over the age of 6, five days of antibiotics appears to be appropriate, as opposed to the old-fashioned, 'Well, you need 10 days.’”
More parents worry that their child will develop an allergy or will have an adverse reaction to antibiotics rather than whether they will become antibiotic resistant, Jackson says, adding that the entire topic should be addressed.
“In thinking about the epidemic of antibiotic resistance, the focus is on stringent diagnosis, appropriate identification of who needs an antibiotic, and, of course, the narrow-spectrum antibiotic for the right length of time, and then counseling on what the adverse effects can be related to antibiotics,” she says. “I am personally invested in all activities to ensure that we’re judiciously using antibiotics, and I’m personally invested and engaged in the activities to study antibiotic resistance and to develop new drugs and or preventatives that will prevent infections.”
Centers for Disease Control: cdc.gov
Infectious Diseases Society of America: idsociety.org
Society for Healthcare Epidemiology of America: shea-online.org
World Health Organization: who.int