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Antibiotics have saved untold millions of lives. But through our overuse we are reducing the number of people who can be saved by this little medical miracle.
When Alexander Fleming accepted the 1945 Nobel Prize in Medicine for the discovery of penicillin and its medical uses, he warned the world about the long-term danger related to the improper use of antibiotics. “The time may come when penicillin can be bought by anyone in the shops,” he said. “Then there is the danger that the ignorant man may easily underdose himself and by exposing his microbes to non-lethal quantities of the drug make them resistant.”
Were Fleming alive today, he would be dismayed at how little his general warning was heeded and distressed at how much worse the problem is than he feared. This is because since Fleming’s time almost the entire range of antibiotics that have been developed have been overused by the population at large, a practice that has accelerated the evolution of antibiotic-resistant bacteria to the point that the World Health Organization (WHO) now calls it “one of the biggest threats to global health, food security, and development today.”
Put simply, antibiotics kill or inhibit the growth of bacteria. But because bacteria reproduce so rapidly and in such large numbers, the naturally occurring “error” rate in DNA replication—genetic mutations—means that within the population of a given bacteria (call it X) there are likely to be members with mutations allowing them to survive an encounter with a given antibiotic (call it Y). Each use of Y results in the total population of X having a slightly higher percentage Y-resistant members. Eventually, the entire surviving population of X will carry the mutation making them resistant to Y, at which point Y is useless against X.
This is evolution in practice, and it is inevitable. All life forms change over time through a combination of genetic mutation and environmental pressure. A University of Berkeley info sheet uses Neisseria gonorrhoeae, the bacteria that causes gonorrhea, as an example. “In the 1960s penicillin and ampicillin were able to control most cases of gonorrhea. Today, more than 24 percent of gonorrheal bacteria in the U.S. are resistant to at least one antibiotic, and 98 percent of gonorrheal bacteria in Southeast Asia are resistant to penicillin.”
Considering that a single antibiotic, penicillin, is estimated to have saved as many as 200 million lives, the value of antibiotics in preserving human life is obvious. But the improper use and overuse of antibiotics is needlessly diminishing their value by accelerating the rate of bacterial change, thus shortening the length of time that antibiotics can protect us.
According to the Centers for Disease Control (CDC), antibiotics are not being optimally prescribed as much as 50 percent of the time. Sometimes this error is as fundamental as prescribing them for ailments on which antibiotics have no effect, such as flu viruses. Take antibiotics for the flu, and you won’t get any relief, but you will contribute to shortening the length of time that antibiotic will prove effective against bacterial infections. As the CDC notes, “Every time a person takes antibiotics, sensitive bacteria (bacteria that antibiotics can still attack) are killed, but resistant bacteria are left to grow and multiply.” Another common mistake is the one Fleming alluded to: not applying a sufficient dosage to treat the infection. Whether that insufficiency comes in the doctors administering dosages that are too weak or patients prematurely ending the course of treatment, for the bacteria the net result is, “Whatever doesn’t kill me makes me stronger”—or in this case, more resistant to the same antibiotic the next time around. Both of these misuses occur at a greater rate in countries where antibiotics can be obtained without a prescription.
While over-the-counter antibiotics are more common in the world’s less-developed nations, a major First World contribution to the overuse of antibiotics has been the their administration to livestock, both to maximize animal growth and to fight off the spread of infections, a particular hazard in the cramped conditions at factory farms. In 2002, the Union of Concerned Scientists reported that eight times more antibiotics were used for this purpose than to help humans fight off infections. Although since then the European Union and the United States have taken steps to reduce such use, China—the world’s single biggest producer and consumer of antibiotics—and many other countries have done little or nothing to curb the practice—bad news, since (as the CDC reports) there is a demonstrated “link between antibiotic use in food-producing animals and the occurrence of antibiotic-resistant infections in humans.”
A contributor to antibiotic resistance clearly trending in the wrong direction is pollution. “Growing antimicrobial resistance linked to discharge of drugs and particular chemicals into the environment is one of the most worrying health threats today,” said UN Environment late last year, noting that “up to 75 per cent of antibiotics used in aquaculture may be lost into the surrounding environment.” UN Environment Chief Erik Solheim warns. “We could be spurring the development of ferocious superbugs through ignorance and carelessness. Studies have already linked the misuse of antibiotics in humans and agriculture over the last several decades to increasing resistance, but the role of the environment and pollution has received little attention.”
All told, The Guardian reports a 65 percent rise in the use of antibiotics between 2000 and 2015. According to UN Environment, this has translated in 700,000 people dying each year of resistant infections “because available antimicrobial drugs have become less effective at killing the resistant pathogens.” A prime example was presented to the world just last month in the form of a super-resistant strain of gonorrhea. As reported by the Washington Post, “Health officials in England said it is the first time that a case of gonorrhea could not be treated successfully with antibiotics that are commonly used to cure it.”
The WHO describes antibiotic resistance as a “serious threat [that] is no longer a prediction for the future [but] is happening right now in every region of the world and has the potential to affect anyone, of any age, in any country. […] Without urgent, coordinated action by many stakeholders, the world is headed for a post-antibiotic era, in which common infections and minor injuries which have been treatable for decades can once again kill. Effective antibiotics have been one of the pillars allowing us to live longer, live healthier, and benefit from modern medicine. Unless we take significant actions to improve efforts to prevent infections and also change how we produce, prescribe, and use antibiotics, the world will lose more and more of these global public health goods, and the implications will be devastating.”
About the Author:
Except for a four-month sojourn in Comoros (a small island nation near the northwest of Madagascar), Greggory Moore has lived his entire life in Southern California. Currently he resides in Long Beach, CA, where he engages in a variety of activities, including playing in the band MOVE, performing as a member of RIOTstage, and, of course, writing.
His work has appeared in the Los Angeles Times, OC Weekly, Daily Kos, the Long Beach Post, Random Lengths News, The District Weekly, GreaterLongBeach.com, and a variety of academic and literary journals. HIs first novel, The Use of Regret, was published in 2011, and he is currently at work on his follow-up. Contact: [email protected]
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