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Antibiotic Risks

Since the 1940s, antibiotics have saved millions of lives. But improper prescribing or use of antibiotics can diminish their effectiveness.

By Rear Adm. Joyce Johnson, D.O.

Alexander Fleming discovered penicillin in 1928, and its medicinal use began in the 1940s. Before then, common bacterial infections killed millions. Children died from complications of strep throat; maternal mortality rates were high due to postpartum infections; and many men died from infected battle injuries.

Since the discovery of penicillin, the Food and Drug Administration has approved many antibiotics for a host of bacterial infections. When each of these antibiotics first was approved, it was effective in treating certain infections. However, over time, bacteria adapt to an antibiotic and change their internal physiology to overcome its effects. It’s a “survival of the fittest” story — a few bacteria are able to survive the effects of an antibiotic. Those few reproduce, and soon many bacteria are resistant to the antibiotic. As those resistant bacteria continue to reproduce, antibiotic resistance becomes more widespread. The process repeats with different antibiotics and infections. More patients become difficult to treat, and for some patients, no effective treatment remains.

Antibiotic resistance is growing in the U.S. and around the world. While some resistance is bound to develop over time, inappropriate prescribing and use have made the problem worse. Doctors might over-prescribe antibiotics (such as for viruses like the common cold), and patients might take them inappropriately (such as not completing a prescribed course of treatment or taking a couple of pills leftover from an earlier prescription). Widespread use of antibiotics in farm animals also diminishes their effectiveness in humans. Misuse by one person affects antibiotic effectiveness for all.

The result: Relatively safe, common antibiotics that worked well in the past increasingly are becoming ineffective. Multidrug-resistant tuberculosis, pneumonia, gonorrhea, and staph infections are more common. In the U.S. alone, the Centers for Disease Control and Prevention estimate 23,000 people die every year from antibiotic-resistant infections.

Efforts are under way to find solutions. Increased surveillance for resistant infections will focus public health efforts. More appropriate use of antibiotics will help slow the problem. New antibiotics take time (more than a decade to reach the market) and money (perhaps $1 billion to develop); relatively few are currently in the pipeline. Approaches to simplify the drug-development process, in terms of both time and cost to market, are under consideration. One possible approach to speed the development of certain antibiotics is to test them for people with specific, difficult-to-treat infections rather than in broader populations.
MO

— Rear Adm. Joyce Johnson, USPHS (Ret), D.O., M.A., is a health care consultant in Chevy Chase, Md. Find more health and wellness resources at www.moaa.org/wellness. For submission information, see page 6.

Legislative Action
The proposed Antibiotic Development to Advance Patient Treatment Act (H.R. 3742) is one current effort to address the dangers of antibiotic resistance.