A World Without Antibiotics
Imagine a world without antibiotics. A simple cut or scrape could become life-threatening. Childbirth would be much more dangerous, for both mother and child. We could return to tuberculosis the old-fashioned way: with just a dose of fresh air. If we don’t get antibiotic resistance under control, this world could become our reality again.
I'm a microbiologist. I love my bacteria. But when it comes to fighting the infections that make us sick, it’s important to understand how smart and dangerous they can be.
The antibiotics we use to fight bacteria are as life-saving as drugs for cancer or heart disease, but people often take for granted their enormous power. We must use antibiotics wisely to avoid creating strains of microbes that are resistant to treatment.
Most people in affluent countries have never grown up with the idea that a simple infection could turn into something serious. If you get strep throat, you can have antibiotics. If you get a skin infection, you get a topical treatment. Before we had antibiotics, infections like scarlet fever could even lead to heart problems. Surgery often led to deadly infections in the blood like bacteremia or septicemia.
Tuberculosis is the classic example of what happened before antibiotics. The treatment was fresh air and bed rest in a sanatorium, and if you were lucky, your immune system could resolve it and you're cured. If not, you get worse and you die. Then the antibiotic streptomycin came along and completely changed how TB is treated.
When George Orwell had TB he had to get special permission from the government of the day to purchase streptomycin in the USA (with proceeds from Animal Farm), because it was only available as part of a clinical trial. It temporarily relieved the worst of the disease and allowed him to finish writing the novel “1984.” It was the equivalent of getting one of today’s expensive cancer drugs or the cure for hepatitis C.
Now, people think of antibiotics as really cheap, something you take for a week, like taking Dayquil for a cold, and you're done. Or they are used to the idea of taking medicine every day for conditions like high blood pressure, and they don’t worry if they miss a few doses. This cavalier attitude is a major health risk. When antibiotics are seen as throwaway items, people don't take their full course or they miss tablets.
If you get an infection and take antibiotics, you’re going to feel better in one or two days, but you still have to take the rest of the course to eliminate all the bacteria from your body. Otherwise, they can grow again, and they can develop resistance to the drug. Antibiotics are actually curing you, not just treating your symptoms.
Often people perceive the decision whether to take their medicine as a personal risk, like mismanaging their money. If you mistreat your bank account, for example, you’re the one who suffers. But if you don't take antibiotics, it’s more than just feeling ill. If you develop a drug-resistant infection, now you could give it to somebody else.
It comes down to understanding the difference between treating the symptoms and curing the disease.
Doctors need to do a better job of explaining to people why they really need to take every single pill. Not only will the germs come back, they will come back worse, and next time we can't use the same drug. Once we’ve gone through the few drugs that we have, poof, there's no treatment.
There are steps the pharmaceutical companies can take as well. One is to make the courses shorter. Azythromycin, for example, is now a three-day course, raising the chances the people will stick with it to the end.
Another approach is to take a new antibiotic and reserve it as the drug of last resort. That's a really good idea practically and clinically, to stop the spread of the resistance, and to keep the drug available. But drug companies understandably want bigger sales.
The farm industry must also stop putting antibiotics in the food of livestock to promote growth and prevent infection. This increases resistance, and over time the resistant organisms can spread further. Bacteria are clever enough to communicate with each other and share genes in different ways; so one species of bacteria that is resistant can transfer that resistance to another bacterial species. In this way, resistance spreads rapidly and can infect humans.
Above all, we need to keep spending on R&D to develop new generations of antibiotics. There’s no such thing as having enough because any new drug will probably be useless in 10 to 20 years.
We're always going to have antibiotic resistance. They're bacteria, they will find a way. In the meantime, we need to respect the antibiotics that we have and use them properly.
Tanya Parish is the Senior Vice President of Drug Discovery at IDRI where she heads the TB Discovery Research group.