We at ACSH have been writing about the dire situation we face because of antibiotic resistance for years. Both Dr. Josh Bloom and ACSH advisor Dr. David Shlaes a world renowned expert in the field have written many times about the looming antibiotic crisis, a time when common infections that were previously treatable are no longer so. In fact, Dr. Shlaes blog, Antibiotics- The Perfect Storm follows the technological, economic, and regulatory facets of the entire crisis, dating back to its beginning.
Finally, this crucial issue is receiving the attention it deserves. In the past two days we have seen an editorial in the Wall Street Journal by the CDC director, Dr. Tom Frieden, an article, also in the Journal about the poultry giant Foster Farms phasing out antibiotic use in feed for its chickens, an FDA news release regarding the use of antibiotics in animal feed, and a news release from the White House about convening a Forum on Antibiotic Stewardship.
This is a very good start, but there is much to be done on multiple fronts, with the discovery and development of new antibiotics almost certainly being the most difficult component of any comprehensive plan. In fact, Dr. Shlaes blog today discusses the complexities and all the moving parts that will have to work together to get new drugs approved.
One of the obvious strategies for slowing the spread of resistance (it cannot be stopped, just minimized) is by a more judicious use of antibiotics in humans, for example, not using them for viral infections, or ensuring that patients take the full course of the drugs when they are used. (Stopping halfway through an antibiotic course is another way of generating resistant organism.)
Perhaps the most controversial aspect of this entire issue is whether antibiotics should be allowed to be added to livestock feed as a growth promoter. The science here is beginning to become clear, and it says that this practice needs to stop.
This holds true for antibiotics regardless of whether they are either the same drugs or members of a class that is used in humans (no brainer), or even antibiotics that are not used in humans. The mechanism by which the latter can generate resistance in antibiotics that are used in people is less obvious.
Dr. Shlaes explains, Bacteria can become resistant to multiple antibiotics by developing molecular pumps that remove the drug from the bacterial cell before it can do any damage. These pumps probably exist naturally to rid the bacteria of waste products and toxins that they either produce or encounter in the environment.
This is why antibiotics that are never used in people can still transfer resistance to bacteria that will enable them to survive in the presence of human antibiotics despite not even having been exposed to them.
Dr. Shlaes goes on: Under certain circumstances, the germs can press the accelerator, and then these pumps work harder and faster. The problem is that these pumps are not very specific and they can pump out a number of unrelated antibiotics. This makes resistance to multiple antibiotics possible. Not such a good thing.
Dr. Bloom predicts, All of these initiatives and policies are fine, but without new antibiotics to combat germs that are already resistant to all or most of the drugs we now have, we are still in all kinds of trouble. Those who are not familiar with the extreme difficulty of discovering new drugs are going to learn how hard this really is. Unfortunately, this is not the best way to learn this lesson.