Entering a Post-Antibiotic Era? What Can Be Done?

Scanning electron micrograph image of
methicillin resistant Staphylococcus aureus (MRSA)

Here is an excellent perspective piece on the problem of antibiotic resistance, as well as possible strategies to combat this issue, that was just published in the New England Journal of Medicine. 

Before discussing the article, here is some background information on antibiotic resistance. The discovery of antibiotics revolutionized medical care; not only were once life-threatening conditions treatable, but the use of antibiotics has been essential to the success of many complicated surgical procedures, for surviving many cancer therapies, et cetera. It has been approximately 84 years since antibiotics were first discovered in the 1920s. Although we initially saw a boom in the production of "new" antibiotic compounds, the creation of new compounds has dropped off dramatically and has not kept pace with the emergence of drug resistance. We are potentially entering a "post-antibiotic era," as bacteria are now routinely encountered that are nearly-and sometimes totally-resistant to all known antibiotics. Someone developing an infection with a multi-drug resistant organism is more likely to die from the infection, and if they survive, more likely to have significant long-term complications from the episode. 

In the aforementioned New England Journal of Medicine article the authors (Spellberg, Bartlett and Gilbert) outline the nature of the antibiotic resistance problem, including the issue of there being a paucity of "new" compounds in the antibiotic production pipeline, especially for resistant bacteria. Our antibiotic arsenal has largely been adapted from nature, where bacteria have been combatting each other with these compounds for millennia. 

The unfortunate reality is that bacteria have already developed counter-measures to the antibiotics we have adopted from nature (resistance to antibiotics). When we use a "new" antibiotic in humans or animals, it does not take long to see the emergence of resistance (as bacteria already possess the means to combat these compounds). 

The authors note several areas where antibiotic resistance can be combatted. They argue for more robust infection control strategies (thereby preventing the development of infections in the first place), making it easier and more lucrative for companies to invest in creating antimicrobials, employing good antibiotic stewardship strategies (preserving the antibiotics we still have) and developing new anti-infective strategies that do not drive antibiotic resistance as much as current therapies. 

It has been less than a century since antibiotics were first discovered and they have only been in widespread use for the last 75 years or so. Given their nature-that they were adapted from nature and resistance to these compounds (and other "new" compounds yet to be discovered) already exists in nature-we have to employ any and all strategies we can to prevent the development of infections, to preserve our existing antibiotic arsenal and to promote the development of new antibiotics and novel strategies to combat infections. We must act now, and collaboratively, if we want to avoid entering the dreaded "post-antibiotic era." 

Some good information on the problem of antibiotic resistance can be found at the CDC.