Originally published in the Journal Inquirer Tuesday, May 20, 2014
By Kristen J. Tsetsi
The results of a recent World Health Organization survey on antibiotic-resistant bacteria led the organization to conclude that “a post-antibiotic era, in which common infections and minor injuries can kill, far from being an apocalyptic fantasy, is instead a very real possibility for the 21st century.”
The medical community has fought bacteria in the past by developing the very antibiotics the bacteria are slowly becoming resistant to, but the National Institutes of Health reported in 2011 that the “development of new antimicrobial agents is on the decline.”
The Infectious Diseases Society of America in 2010 asked for 10 new antibiotics by the year 2020, a goal Dr. Ulysses Wu, chief of infectious diseases at Saint Francis Hospital and Medical Center in Hartford, doesn’t believe will be achieved. He explained that the slow development of new drugs is largely a result of the pharmaceutical companies’ preference for what will earn the most profit.
“The dirty secret is that drugs are not being made anymore,” Wu said. “Part of it is that we’re a failure of our own success. Antibiotics work. Drug companies don’t really want to invest billions of dollars into a drug you’re only going to take for seven days. They’re interested in lifelong drugs. Alzheimer’s, cancer, high cholesterol, high blood pressure. If you look over the past 25 years, not that many antibiotics have been developed, but a large amount of HIV drugs have been developed, and a lot of new drugs are coming out for hepatitis C.”
The combination of resistant bacteria — which Wu attributed to a combination of antibiotic-overuse by patients and physicians and the injection of antibiotics into the food supply — and fewer new antibiotics prompted the NIH in 2011 to call for “antimicrobial stewardship.” This was soon followed by the InterAcademy Medical Panel’s joint statement, “Antimicrobial Resistance: A Call to Arms,” and last week the Connecticut Department of Public Health’s own call to action to “to establish effective antimicrobial stewardship programs.”
The stewardship being called for is essentially more judicious use of antibiotics by hospitals and physicians.
“We’re trying to limit that use and target it,” Wu said. “An analogy would be saying, ‘You have an illness. We could use a pistol instead of a cannon ball in trying to figure out what it is.’”
Patients are strongly encouraged to play a role in stewardship as well, in large part by recognizing antibiotics aren’t appropriate for all illnesses. The Centers for Disease Control and Prevention report that 20 to 50 percent of antibiotics prescribed in the hospital are either unnecessary or inappropriate. Wu said doctors prescribing antibiotics are often making their best educated guess — “There are lots of different factors to prescribing antibiotics, and the general physician will take into account most of those factors” — but they’re also responding to patient demands.
“Sometimes it’s much easier for a physician to not argue with a patient,” he said. “Rather than explain, ‘This is likely a virus, it will take time to go away and antibiotics aren’t going to help,’ it’s, ‘You have a head cold. Take this.’ We are a satisfy-me-now type of society, and we’re asking for these drugs.”
Ironically, our insistence on taking too many drugs to make us feel better will only harm us in the end. Eventually, Wu said, we will run out of antibiotics and more bacteria will become fully resistant. Cases already exist, he said, involving patients who can’t be prescribed antibiotics because they simply won’t work on the bacteria.
The cases are sporadic — “It’s not at an endemic level, by any stretch,” Wu said — but it’s a shifting tide, he said, and the danger is certainly coming, whether a year from now or several years from now.
He encouraged consumers to have a cognitive and coherent conversation with the healthcare provider to determine the best course of action, which may or may not include the use of antibiotics.
The idea is that fewer people using antibiotics will over time limit the number of drug-resistant bacteria. They are prone to mutate in the environment they’re in, Wu said, so the fewer antibiotics they’re exposed to, the fewer mutations that will occur.
“By being stewards, we can slow the rate of resistance,” he said.