Protecting a Valuable Natural Resource: Antibiotics

Nov 15, 2012, 4:15 PM, Posted by Ramanan Laxminarayan

Ramanan Laxminarayan Ramanan Laxminarayan

Antibiotics are a shared resource for protecting the public’s health. Since their introduction in 1941, antibiotics have saved millions of lives and transformed modern medicine. But the more you or I—or anyone—uses antibiotics when we don’t need them, the more we contribute to the development of antibiotic-resistant microbes—and to the frightening prospect of a world where most infections don’t respond to antibiotics. If we don’t take collective action soon, this unthinkable scenario could become a reality.

To many who have heard these warnings before, antibiotic resistance seems like an evergreen issue that is always off in the distance. That is simply no longer true. We lose more people to just one kind of drug-resistant infection—methicillin-resistant Staphylococcus aureus—than to HIV. The cumulative toll from all resistant infections in the United States is much greater. Each and every one of us has a responsibility to protect the arsenal that we have—those antibiotics that are still effective—to fight deadly pathogens.

That is why, at the start of this year’s “Get Smart about Antibiotics Week,” we at Extending the Cure (ETC) have come together with the Centers for Disease Control and Prevention and 25 of the nation’s leading health care organizations to issue a Joint Statement on Antibiotic Resistance. The statement demonstrates a strong, unprecedented consensus around a set of principles for both conserving and replenishing antibiotic resources. Organizations representing a range of fields concerned with human health have joined us in signing this statement, all recognizing that unsustainable use of antibiotics, combined with a dearth of new drugs, threatens to usher us back to an era when common infections were incurable or very costly to treat.

New ETC research highlights just the latest instance of this growing danger. The Drug Resistance Index tool reveals that urinary tract infections (UTIs), the second most common type of infection in the United States, are 30 percent less treatable than they were 10 years ago. The antibiotics we use to treat UTIs are losing their effectiveness. Without proper treatment, UTIs can turn into bloodstream infections, which are considerably more serious and can even be life-threatening. We will need new drugs to target bacteria that have become resistant to currently available antibiotics, but without better approaches to delay resistance, these too will become rapidly obsolete.

Overprescribing of antibiotics is a significant driver of drug resistance. National initiatives such as CDC’s Get Smart week may have improved awareness among parents and family physicians, and helped curb antibiotic consumption since its 1990s peak. However, progress is not uniform and some parts of the country continue to use antibiotics at high rates that are unjustified by their burden of bacterial infections. Using a newly updated ResistanceMap tool, we find that states in the Southeast consume more than twice as many antibiotics as those in the West. Moreover, this regional gap is widening over time, suggesting that the problem is getting significantly worse in some parts of the country.

Why might this be? High antibiotic use rates could reflect a widespread social norm that makes it acceptable for consumers to demand antibiotics and for physicians to prescribe them—even when they aren’t needed. In these cases, patients could be seeking a quick cure for a cold or the flu, neither of which respond to antibiotics. Patients and doctors alike must resist the urge to use antibiotics unnecessarily, but that’s only part of the answer.

Our Joint Statement recognizes that comprehensive, incentive-based policies are needed to combat the growing danger of antibiotic resistance and preserve antibiotic effectiveness. We believe the best solutions will require not only judicious prescribing but also tighter infection control measures, enhanced surveillance of drug-resistant infections, better coordination of regional efforts among hospitals and in the community, and incentives for new drug development.

The costs—both human and economic—posed by rising antibiotic resistance rates are serious. While regional differences exist, this is a problem without borders. Each of us has a role to play in preserving antibiotic effectiveness and keeping deadly microbes in check if we want our children and grandchildren to benefit from this precious resource.

This commentary originally appeared on the RWJF Pioneering Ideas blog.