While savvy consumers know not to trust the flood of questionable and untested remedies presented in internet advertisements or late-night television infomercials, most people wouldn’t think twice about the effectiveness of a doctor-prescribed medication. That’s especially true of the ubiquitous use of antibiotics. So it might surprise many people to learn that more and more antibiotics are becoming obsolete as microorganisms evolve to defeat them. What leads to the development of these “Super Bugs” and what can be done to effectively combat them?
Antimicrobial agents, comprised of antibiotics and similar drugs, have been an integral part of modern medicine since they became widely available in the 1940s. Penicillin, discovered in London in 1928 by Alexander Fleming and perfected a decade later by Howard Florey, Ernst Chain and others at Oxford University, was the first such medicine made widely available, being produced in large quantities to accommodate the military need during World War II. Although Penicillin is broadly effective and very safe, it lacked the ability to combat Tuberculosis, a major health hazard of the time. In 1944, Selman Waksman, Albert Shatz, and Elizabeth Bugie discovered an antibiotic, streptomycin, capable of fighting the deadly disease. Tuberculosis was brought under control in America by 1950, and a slew of other antibiotics were being developed to fight other diseases that penicillin couldn’t handle (“History of Medicine”). These wonder drugs have been a vital tool in fighting infectious diseases and have improved overall health in the world and saved countless lives. However, they are not a perfect remedy.
New strains of tuberculosis have surfaced that are resistant to common drug treatment. About 650,000 cases of multidrug-resistant tuberculosis were reported in 2010, with roughly 440,000 new cases and 150,000 deaths each year. Roughly 9% of cases involve extensively drug-resistant tuberculosis, a strain that is treatable by far fewer medicines (“Tuberculosis”). Tuberculosis is not alone; antimicrobial resistant strains of many diseases, such as staphylococcus aureus, are a major problem in the world today. These adapted pathogens make treatment difficult, resulting in lengthy sicknesses, the potential for greater spread of disease as sufferers remain infectious longer, complicate the treatment of other conditions (especially many surgeries and cancer treatments) and in many cases death (“Antimicrobial Resistance.”) Resistant diseases also cause a drastic increase in health care expenses: as much as $4-5 billion in the US and $9 billion in Europe (“Medicines: Rational Uses of Medicines.”)
Diseases are always evolving to more effectively battle antibiotics. Either through mutation or the transfer of DNA from other microbes, they acquire the ability to neutralize antibiotics before they can be effective, purge antibiotics quickly, or alter the antibiotic attack site to be ineffective. Antibiotics create “selective pressure” that causes these abilities to proliferate through natural selection (“Antibiotic Resistance Questions & Answers”). Although this evolution is natural, it has been exacerbated by the misuse and overuse of antibiotics. Doctors may over prescribe, prescribe antibiotics that target the wrong agent or prescribe antibiotics to patients with a viral infection as a placebo. Unscrupulous pharmaceutical companies may even target sales at people who don’t need the antibiotics. Poorer patients may be forced to use cheap alternatives or substitutes that are less effective. Patients may fail to follow doctor or pharmacist instructions; skipping doses, not finishing a regiment of antibiotics, or saving antibiotics (which lose effectiveness over time) for later. Additionally, prevalent antibiotic use in the food industries leads to further unnecessary exposure. All of these practices can give microbial agents the opportunity to develop resistance (“Medicines: Rational Uses of Medicines.”)
Agencies like the World Health Organization and the Interagency Task Force on Antimicrobial Resistance are taking steps to combat these problems. Efforts focus on greater regulation on the use of antibiotics/antimicrobials, prevention of interruption of supply, providing for better diagnostic capabilities, surveillance to identify problems with resistant strains, educating the public about what diseases can and cannot be treated by antibiotics and the development of new antibiotics and other treatments (“Antimicrobial Resistance.”) These diseases will continue to adapt, so the problem of resistance will never go away, but with the proper, perhaps more restrained use, of antimicrobial medications and continued development of new drugs, our ability to fight these pathogens could outpace their ability to overcome our treatments. However, if our efforts to slow the development of resistant strains are successful, the dangers of infectious diseases could return to levels not seen in nearly a century.
Works Cited
“Antibiotic Resistance Questions & Answers.” Cdc.gov. Center for Disease Control and Prevention, n.d. Web. 12 April.
2012. <http://www.cdc.gov/getsmart/antibiotic-use/antibiotic-resistance-faqs.html>
“Antimicrobial Resistance.” World Health Organization. World Health Organization, 2012. Web. 12 April. 2012.
<http://www.who.int/mediacentre/factsheets/fs194/en/>
“History of Medicine.” Encyclopaedia Britannica. Encyclopaedia Britanncia Online. Encyclopaedia Britannica Inc., 2012. Web.
12 April. 2012. <http://www.britannica.com/EBchecked/topic/372460/history-of-medicine>
“Medicines: Rational Use of Medicines.” World Health Organization. World Health Organization, 2010. Web. 12 April.
2012. http://www.who.int/mediacentre/factsheets/fs338/en/
“Tuberculosis.” World Health Organization. World Health Organization, 2012. Web. 12 April. 2012.
<http://www.who.int/mediacentre/factsheets/fs104/en/>
