Imagine scraping your knee. In the 1900s, before antibiotics (and sanitation laws) were discovered, that wound could have led to bacterial infection and possible death. Today, deaths due to infectious disease have been cut to 5 percent since the dawn of the era of antibiotics. In countries where antibiotics are not prevalently used, strep throat can lead to serious rheumatic fever, tuberculosis can become fatal, and chlamydia can escalate to infertility. While antibiotics were an effective, reliable way to treat these infections in the past, the modern misuse and overuse of antibiotics has compromised their functionality.
Now, bacterial strains are becoming increasingly resistant to the few antibiotics on the market, gaining “superbug” status. Since antibiotics are ineffective against these superbugs, normal infections are becoming untreatable and, thus, life-threatening. Even in developed countries, only 50 percent of patients are responding to some antibiotics that were very potent in the past. These “superbugs” are gaining the upperhand in our fight against bacterial infections, and pose a serious threat to global health security. To address these urgent concerns, President Obama issued an executive order on September 18th, 2014, declaring war on antibiotic-resistant bacteria.
According to the Center for Disease Control and Prevention, antibiotic-resistant infections are responsible annually for 2 million illnesses in the U.S, $20 billion in health care costs, and $35 billion in lost productivity from hospitalizations and sick days. In addition to the economical burden, these “superbugs” drastically impact the practice of medicine: Antibiotics are imperative in modern medicine for fighting bacterial infections after surgery, transplants, and chemotherapy. Without the promise of effective antibiotics, these complicated medical procedures become unviable due to significant concern for post-treatment complications.
Bacterial resistance is obtained as follows: Antibiotics target a specific property of bacterial cells in fighting them. While most bacteria are impacted by drug’s mechanism, a mutation in just one bacterial cell’s DNA can affect its susceptibility to the antibiotic. Now this one cell is immune to the antibiotic, and it reproduces to create a cluster of antibiotic-resistant bacterial cells. As all the other non-mutated bacteria are killed by the antibiotics, the mutated resistant bacteria are unaffected and propagate. With bacterial resistance, the question is not if the strains will pick up resistance, but rather when. By optimizing the use of antibiotics, antibiotic potency will last longer. Therefore, the more exposure an antibiotic has to bacteria, the more chance it has of encountering a mutated bacteria, and thus triggering resistance.
President Obama’s executive order comprises of a plan for action that will limit and control use of antibiotics in medicine and agriculture (in order to decrease antibiotic exposure) and develop new medicines and technologies to combat the “superbugs.” In research, the plan encourages the discovery of new antibiotics, vaccines, and diagnostic tools. New antibiotics are needed to treat patients with serious infections, for which few to no drugs are available due to that particular strain’s resistances. Vaccines that confer immunity against certain bacterial strains would circumvent the need for antibiotics.
The Center for Disease Control and Prevention estimates that 50 percent of antibiotics prescribed are unnecessary or incorrectly prescribed. Bioinformatics and metagenomics can be used to develop a ‘point-of-care” diagnostic tool that would quickly identify the type of bacteria and its particular antibiotic susceptibilities to prevent misdiagnosis by doctors. This technology would be utilized as soon as a patient walks into a doctor’s office with a bacterial infection: By the time the visit is over, the doctor will have enough information to prescribe the best-suited antibiotic according to the bacteria’s profile.
During wartime, when bacterial infections were a pervasive cause of death on the battlefield, the antibiotic industry was born. “A short golden age of antibiotic discovery from nature followed by a subsequent golden half century of medicinal chemistry optimization of existing molecular scaffolds emphasizes the need for new antibiotic molecular frameworks,” reads a paper published by Walsh and Wencewicz. For the last few decades, not much innovative effort has gone into overcoming bacterial resistance. Researchers, like Dr. Wencewicz of Washington University in St. Louis, are looking for new mechanisms to target these “superbugs” so that the effectiveness of these next-generation antibiotics can last longer than the current 1-2 year potency period. Yet, the shrinkage of the R&D sector of the pharmaceutical industry limits access to the expertise and cooperative facilities crucial for drug development.The effectiveness of the Executive Order depends on the cooperation of the government with big businesses, practicing doctors, farmers, and researchers. Overall, with more regulation and research, the U.S hopes to defeat the “superbugs”–perhaps once and for all.