Every year, at least 2 million Americans become infected with bacteria that are resistant to antibiotic treatment, and 23,000 of them die. “Superbugs” flourish largely because antibiotics have been overused for decades, and last month, the federal government announced a new plan to beat the bugs at their own game.
The goals of the Obama administration’s multi-front attack on antibiotic resistance (AR), explained Medscape.com in “Special Report: Antimicrobial Resistance – Time for Change,” are to:
- slow down the emergence and spread of resistant bacteria;
- track the progress of bacteria better;
- speed up the development of new antibiotics; and
- improve international collaboration for the prevention, tracking, control of and research for AR.
No one needs evidence of the need to fast-track better antibiotics, but Dr. Barbara Murray’s recent testimony before a Congressional subcommittee drew a very stark picture. A young patient with lupus developed a severe infection that did not respond to any available antibiotic, or even surgery. “We sent her to hospice for comfort care while she waited for the infection to claim her life after a very long and expensive stay in the hospital,” recalled Murray, president of the Infectious Diseases Society of America.
Murray also told the story of two women who had to be hospitalized to treat urinary tract infections. They weren’t seriously ill (urinary tract infections usually aren’t serious), but they were resistant to oral antibiotics. So they had to get more invasive treatment. “Having to be hospitalized for a common infection is inconvenient, decreases productivity and increases health-care costs,” Murray told the lawmakers.
Murray told Medscape, “I’ve been [treating infectious diseases] for years, and I’m scared. I don’t want to go to the hospital. This is the first time I’ve felt this way.”
In announcing the new initiative, Dr. Thomas Friedan, head of the Centers for Disease Control and Prevention (CDC), called AR “an urgent health threat, and a threat to our economic stability as well.”
“The estimated annual impact of antibiotic-resistant infections is $20 billion in direct health-care costs, and far more in lost productivity,” he said.
Some people even consider superbugs a security threat. John Holdren, director of the White House Office of Science and Technology Policy, told Medscape, “What we see … is the potential for [a] runaway spread of infection, which ultimately, as they go to very large scale, undermines social stability. We see the potential for [an] enormous increase in costs, which can reduce the capacity of the country to respond to other threats.”
Although ebola is a virus, not a bacterium, it’s an example of what Holdren’s talking about.
The new initiative creates a task force whose five-year “national action plan” to implement the strategy is due in February. That panel includes the heads of the departments of Health and Human Services, Defense and Agriculture, and, among other tasks, must propose ways the government can make it easier for drug companies to develop new antibiotics.
The problem of drug-resistant bacteria is the result of many factors, including doctors who prescribe antibiotics carelessly. According to Medscape, about 1 in 5 antibiotic prescriptions is written when the prescriber is not sure it’s needed. Frieden said as many as 1 in 3 or even half of all antibiotic prescriptions in the U.S. are either unnecessary or are inappropriately broad-spectrum.
Broad-spectrum antibiotics are meant to treat a wide variety of microbial attackers; narrow-spectrum drugs are directed to more specific invaders. If you prescribe a broad-spectrum drug when a more narrow one is appropriate, you help microbes build resistance to more drugs faster.
As we’ve explained in previous blogs, often, antibiotics are prescribed to satisfy patients who don’t feel well, and simply want their doctors to do “something.” They might not even have an infection, or their infection might be caused by a virus, not a bacterium. Antibiotics do not address viruses, only bacteria.
Many common infections, such as sinus infections, resolve in time without the use of prescription drugs. So the wisest use of antibiotics is for serious infections, such as MRSA, C. diff. and gonorrhea.
But the drug-resistant horse has already left the barn, so we need to do something to strengthen the antibiotics prescribed in the future.
That includes renewed efforts by the FDA to eliminate the use of antibiotics in agriculture to promote growth in livestock, because antibiotics aren’t overprescribed only for humans (see our blog, “FDA’s Weak Plan to Phase Out Routine Use of Antibiotics in Animals.”)
The feds also are sweetening the deal with cash: A $20 million prize will go to the individual or group that develops a rapid point-of-care diagnostic test to spot highly resistant bacterial infections. It’s not a new idea; in Britain, $17.1 million also is offered for the development of a speedy point-of-care test for antibiotic-resistant pathogens.
To learn more about antibiotic resistance, and what you can do about it, visit the CDC’s antibiotic information site here. To read the Executive Order and National Strategy to Combat Antibiotic-Resistant Bacteria report, link here.