The Real Threat

Antibiotic resistance is expected to kill 10 million people by 2050 at a cost of 78 trillion dollars to the global economy, according to The Review on Antimicrobial Resistance carried out by the UK government. Antibiotic resistance is one of the most threatening global threat, and arises when bacteria are exposed to certain or multiple antibiotics and, due to natural selection, the ones with preexisting genetic traits that favor survival are able to reproduce and have resistant offspring. Over time, a population of resistant bacteria emerges. These multiple resistant-bacteria are categorized as superbugs.

Evidence of antibiotic resistance is currently found in every country in the world. Yet public awareness is low, especially in the United States. Each day, millions of people are treated with antibiotics to fight infectious diseases. But because of evolution and natural selection, the bacteria are fighting back.

Antibiotics revolutionized the field of medicine. Before antibiotics, a simple wound or cut could have been life-threatening. Antibiotics are natural, synthetic or hybrid molecules that inhibit growth or kill bacteria inside the host cells by a variety of mechanisms. The first commercial antibiotic, penicillin, was released during World War II. The introduction of antibiotics changed the landscape of healthcare and hospitals, but even the creator of penicillin, Alexander Fleming, saw a threat coming.

Fleming, in his Nobel Prize acceptance speech, said: “I would like to sound one note of warning… It is not difficult to make microbes resistant to penicillin in the laboratory by exposing them to concentrations not sufficient to kill them, and the same thing has occasionally happened in the body.”

The threat has been real from the start, but only now are governments realizing the disastrous consequences and implications of such a phenomenon.  

The seriousness of this threat exponentially increases each day as more antibiotics are used without regulation. According to the Centers for Disease Control and Prevention, at least 2 million people become infected with bacteria that are resistant to antibiotics, and at least 23,000 people die each year as a direct result of these infections in the U.S.

Antibiotics are most likely to be prescribed when a patient is suffering from an existing bacterial infection. But what is also important is the role of antibiotics in standard surgical procedures. Without antibiotics, high-risk as well as low-risk procedures cannot be performed at all, such as organ transplants, chemotherapy, diabetes treatment and even cesarean sections.

“If we fail to act, we are looking at an almost unthinkable scenario where antibiotics no longer work, and we are cast back into the dark ages of medicine where treatable infections and injuries will kill once again,” former U.K. Prime Minister David Cameron said at a G-7 leaders meeting in 2014.

University of Richmond’s biology and chemistry departments are well aware of the dangers of antibiotic resistance and believe that awareness and education are keys to combating antibiotic resistance. They developed a year-long program, called Science, Math and Research Training (SMART), that integrates biology, chemistry, and calculus in order to learn about two global health problems: antibiotic resistance and HIV. In a semester-long course solely dedicated to antibiotic resistance, the students learn the biological mechanisms and chemical components of antibiotics and the evolutionary processes of resistance.

“By the experiments we did, I realized how fast resistance occurs,” Shabethany Sawyer, a sophomore and former participant in SMART, said. “It often only takes one generation of bacteria to reproduce for it to develop resistance and spread among the bacterial population.”

The first step for combating antibiotic resistance is regulation and public awareness. The Food and Drug Administration specifies that antibiotics are prescribed to treat bacterial infections, not viruses. Colds and flus are not meant to be treated with antibiotics, a fact of which the general public is relatively unaware.

Both patients and healthcare professionals can do their parts to fight antibiotic resistance. Health care professionals should perform thorough examinations and tests to provide an accurate diagnostic before prescribing antibiotics. Patients should also not take antibiotics when they are not needed. A persistent problem is the ease of acquiring antibiotics over-the-counter. A simple Google search can enable someone to buy cheap antibiotics without regulation or prescription.

The FDA has been increasingly labeling antibiotics with restriction guidelines, raising public awareness and promoting the development of antibiotics. The weakest factor among these is the latter. There is a high cost to produce and synthesize new antibiotics, but the profit return is minimal when they are introduced into the market. Antibiotics carry a relatively small price tag when compared to other mass production drugs. Therefore, pharmaceutical companies see little economic advantage to producing more antibiotics.

The next step, if the healthcare and pharmaceutical sectors are not enough to combat this global crisis, is an aggressive public awareness campaign fostering educational, economic, social and regulatory environments that can effectively battle antibiotic resistance.

April Hill, the chair of Richmond’s biology department and former SMART professor, shared these concerns. “Not a lot of people are not dying of an untreated bacterial infection yet,” she said. “There is not a lot of money in antibiotic development because is there is not yet a crisis in the United States. There is not much money thrown into development of new antibiotics because there is no profit to be made and no urgency for the need of new antibiotics.”

This past September, the United Nations General Assembly had a high-level meeting to discuss the perils of antibiotic resistance. This was only the fourth time in history the General Assembly had discussed a health-related topic. The other three instances were for outbreaks of HIV, Ebola and noncommunicable diseases.

“I think [antibiotic resistance] is the harbinger of future badness to come,” said James Johnson, a professor of infectious diseases medicine at the University of Minnesota. “People have asked me many times, ‘How scared should we be? How close are we to the edge of the cliff?’ And I tell them, ‘We’re already falling off the cliff.’”

Each year, the number of resistant bacteria strains grows at alarming rates, as do the cases involving health complications due to antibiotic resistance. In Nevada, a woman contracted Klebsiella pneumoniae, which causes pneumonia, bloodstream infection and meningitis. The superbug prevailed against all 14 available and procedural antibiotic treatments the hospital administered. She died of multiple organ failures and sepsis, a bloodstream inflammation that occurs in response to bacteria. Further tests at a CDC lab showed the bacterial strain was resistant to 26 antibiotics.

“I think in the coming years when the situation reaches a tipping point, contemporary history will be divided into two: an antibiotic world and post-antibiotic world,” Sawyer said. “And a post-antibiotic world is not a place I would want to live in.”

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