The biggest threat to modern medicine — antibiotic resistance

For only the fourth time in United Nations (UN) history, a health issue was the focus of a general assembly meeting: All 193 UN members will sign a declaration agreeing to fight the biggest threat to modern medicine, which is antibiotic resistance. This as a global crisis which requires global response.

The discovery of antibiotics by Alexander Fleming in 1928 is one of the greatest medical advances ever. How did something so right turn out to be so wrong in less than 100 years?  

{mosads}While antibiotics can be lifesaving, even Fleming recognized the potential for antibiotic resistance — also called antimicrobial resistance (AMR) — when he accepted his Nobel Prize in 1945.

When infectious organisms — primarily bacteria, but also viruses and fungi — are exposed to a sub-lethal dosage of an antibiotic, they can mutate and develop resistance to that medicine. After that happens other individuals may also become infected with resistant strains.

These pathogens are called “superbugs” because they cause infections for which we have limited or no effective treatments. They can spread quickly, and internationally. The UN estimates that over 700,000 people die annually from drug-resistant infections.

That number is projected to increase to 10 million by 2050 if preventive measures aren’t introduced quickly and globally. In the US, The Centers for Disease Control and Prevention estimates that 23,000 people die annually from AMR infections and more than 2 million people are infected with AMR infections.

When mortality statistics alone don’t motivate action, projected economic losses do. A British report predicted global production losses of $100 trillion between now and 2050 if international AMR initiatives weren’t implemented soon.

Factors contributing to antibiotic resistance include, individuals not taking the complete dose, taking antibiotics from previous infections, and taking someone else’s antibiotics.

From the physician’s perspective, providers sometimes prescribe antibiotics incorrectly — prescribing antibiotics for viral infections — succumb to patient pressures to prescribe or they may even prescribe prophylactic antibiotics unnecessarily.

However, the greatest cause of antibiotic resistance is antibiotic exposure in our food and water. While improper disposal is a factor, the predominant cause of antibiotic overexposure is their excessive use in animals and fish as growth factors by preventing infections in increasingly overcrowded living conditions.

In the US alone, Pew Trusts estimates that 70 percent of medically important antibiotics are given to animals in our food supply.

It has been widely reported that the UN members have agreed to facilitate ongoing innovation in antibiotic development, to increase public education, and to enhance regulatory systems on the sale and uses of antimicrobial medicine for humans and animals.

To address these challenges, governments will convene task forces and galvanize health agencies to draft action plans with the input of physicians, researchers, hospitals, medical organizations, nongovernmental organizations (NGO) and pharmaceutical companies.

But there are several critically important action steps that individual health care providers and individuals can start today:

1. Practice infection prevention: review with your children, patients, constituents, customers, co-workers, & employees. Here, an ounce of prevention is truly worth ten pounds of cure. There is no substitute for frequent hand-washing and staying home from work if you have a contagious illness. Cough into your elbows rather than your hands. Don’t share food or drinks if you have a cough, cold or flu and don’t kiss others on the lips then. Antibacterial cleaning products aren’t more helpful than regular ones and may also contribute to AMR.

2. Vaccines are our primary tools to prevent infectious diseases and to reduce secondary infections. For example, many elderly people who get the flu may also develop pneumonia; kids with chickenpox can develop skin infections from scratching. It’s important to speak with your healthcare provider or pharmacist annually to review which vaccines you or your children may need.

Not only have new vaccines have become available (eg. Meningitis B vaccine), but vaccine guidelines may changed. Most vaccine preventable illnesses are viral and can be treated with antiviral medications, but people who aren’t in a high risk group generally don’t need them. Viral illnesses are often misdiagnosed or mistreated (eg. prescribing antibiotics for the flu).

Now is a great time for all adults to confirm that their vaccines and their children’s  are current. The annual flu vaccine is now available for anyone over six months old without contraindications. Many people confuse the guidelines for the flu and pneumonia vaccines; ask your healthcare provider or pharmacist which ones you may need and keep an updated copy of your records.

3. Dispose of any unused antibiotics in the trash; don’t flush them down the toilet.

5. Reduce your consumption of fish, meat, poultry, milk and eggs from antibiotic fed sources. You don’t have to become vegetarian, but choose locally sourced organic products whenever possible. Eat recommended portion sizes and decrease the frequency of consumption.

5. If you are prescribed antibiotics, use them correctly. Always complete the full course of therapy; don’t stop taking them when your symptoms abate. Don’t save some of your prescription for next time. Don’t share your prescription with anyone, even if they have the same symptoms. Don’t pressure your healthcare provider (or your neighbor who is a doctor) to prescribe antibiotics you may not need, especially remotely. If you are sick enough to be prescribed antibiotics, you are sick enough to be examined. If you can’t get to your doctor, local pharmacy clinics are options. Finally, if a doctor ever told you to take antibiotics before dental procedures or surgery, ask if that is still the case since many of these guidelines have changed.

Donnica L. Moore, MD is the President of Sapphire Women’s Health Group. You can find her on Twitter: @DrDonnica

The views expressed by contributors are their own and not the views of The Hill.