An ambitious plan to stop the rise of superbugs

Antibiotic resistance is here to stay, but that doesn't mean there's nothing we can do to stop it.

One title that always attracts my attention is that antibiotic resistance is on the rise. Behind these headlines is the fact that the pathogenic bacteria that make us sick are less and less sensitive to treatment with our most common antibiotics. If you read beyond the headlines, you will see that the World Health Organization (WHO) predicts that by 2050, antibiotic-resistant bacteria (ARM) will kill 10 million people a year. This would put ARBs ahead of cancer as the leading cause of death worldwide. These headlines assume that the world cannot do anything to intervene.

We are not unified

American hospitals are taking steps to limit ARBs. For some patients, all those who come into contact with them must wear a gown and gloves. This practice limits the spread of ARBs throughout the hospital. Another control is to prevent the overuse of our most powerful antibiotics to stop the evolution of ARBs. Usually you have to call an infectious disease specialist like me to access these drugs. These two basic components of antibiotic stewardship have proven to be very effective in limiting ARBs.

We still see ARBs because not all hospitals strictly adhere to these practices and the application of antimicrobial stewardship in hospitals is not consistent.

The problem is exacerbated by the fact that some hospitals do not routinely screen patients for antibiotic-resistant microbes. There are patients who carry ARBs in their microbiomes and it is quite difficult to block the spread if you do not know who carries them.

Together, these strategies can limit IAM in a single hospital, a part of the city or even an entire city. But you may still be losing the battle through your state. So what can our leaders do to limit the use of IBAs?

How to reduce antibiotic resistance?

Ultimately, an alternative to antibiotics must be found. A new industry has emerged that focuses on the use of viruses to kill bacteria, but these efforts have been inconsistent.

Bacteriophages have been used successfully in a few recent cases to treat ARBs. A patient with a severe skin, liver and lung infection and a man with a potentially fatal ARB were both successfully treated with bacteriophages, giving great hope for the future of phage therapy.

However, these cases provide only anecdotal evidence of the effectiveness of these therapies. They fall far short of the FDA's stringent efficacy standards for antibiotics. The government should encourage high-quality and replicable studies to support the use of these antimicrobial agents in order to better understand their potential for treating ARBs in the general population.

The United States must also invest in the development of antibiotics that attack bacteria in new ways. The government must have an incentive policy to encourage industry to address this problem because market forces do not encourage huge investments in antibiotic development. This is because most patients use an antibiotic once every two or three years for a few weeks at a time to treat infections. Compare this to a heart medication that patients must take daily for the rest of their lives; it is clearly more lucrative.

Other strategies that the United States could adopt include consistent antibiotic screening and management practices in all of its hospitals. Physicians may not like having a governing body involved in their practice, but the United States must reduce unnecessary antibiotic prescriptions. And the United States must limit antibiotics in livestock. This could have a huge impact.

Finally, once the United States has made these efforts, it will have to export them to the rest of the world. Implementing these changes in the United States will not be enough to reverse this trend; but if we are serious about changing the trajectory of ARBs and developing alternatives to antibiotics, all options must be on the table.

I am an infectious disease medical scientist who has been at the forefront because the number of ARB cases is increasing. I am also part of a group of researchers developing bacteriophages - viruses that kill bacteria - as alternatives to antibiotics as an additional way to limit ARBs in the United States and around the world.

To understand why ARBs are approaching critical levels, it is important to understand the limitations of antibiotics and the trends that contribute to them.

Antibiotic development has its limits

People have been using antibiotics to treat infections since the early 1940s, but naturally produced antibiotics are millions of years old. These drugs are derived from natural products that bacteria and fungi use to fight other bacteria. They use these products to eliminate their competition.

Most antibiotics produced by the industry have one thing in common: they work the same way. They block the bacterium's ability to produce proteins, DNA, RNA or even its cell wall, which have deadly consequences for the bacterium. Thus, most new antibiotics are not based on new ways of killing bacteria; they are simply incremental improvements.

Therefore, when a bacterium develops immunity to one of these antibiotics, it often develops resistance to the entire group of antibiotics. Simply put, a single resistance event can cause us to lose quite a few antibiotics that were effective against this bacterium before.

Antibiotic resistance may be right under your nose.

Much of the ARM problem is caused by humans. Bacteria often become resistant to antibiotics after exposure to these drugs. The simplest way to think about this concept is: "What can push, will push, will push!" You have a body full of microorganisms called your microbiome-which includes about 38 trillion bacteria. While the antibiotic you take kills the bacteria that make you sick, it also kills many other good bacteria that are harmless. This leaves you with a microbiome populated with many bacteria that are resistant not only to this antibiotic alone, but often to the whole group. Because only ARBs can develop in this environment, your microbiome becomes largely populated with ARBs. This means that even healthy people who have taken antibiotics in the past can shelter ARBs.

The problem is further exacerbated when one considers the unnecessary use of antibiotics worldwide. Doctors use antibiotics in people with viral infections even if they do not work. Farmers feed them to animals to accelerate their growth and give them health benefits. More than 70% of all antibiotics used worldwide are of animal origin, and you can also be exposed to antibiotics simply by handling and eating meat from animals raised on antibiotics. All these exposures contribute to increasing global antimicrobial resistance.

If we know the root causes of antimicrobial resistance, why is it still present? It may seem that doctors and scientists have witnessed all this without doing anything. This is not correct.