A Dire Emergency in Human Health

Too many antibiotics prescribed and too much resistance to them — the problem is enormous

It’s understandable: When you’re sick, you want something to make you feel better. But all of us must seriously question whether or not we need antibiotics — and if a doctor’s prescription for them is the right thing or not.

Antibiotics are still being handed out to patients when they shouldn’t be, a new survey of U.S. doctors found. Nearly a third of doctors actually admitted to writing out a prescription knowing it wouldn’t help, according to the American College of Physicians.

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Long-term, this could put us at risk for infection with antibiotic-resistant bacteria — essentially, when we need a drug to cure an infection, we’ll be lucky if there’s anything that will work.

Complicating this problem is a growing resistance to antibiotics, including antibiotics of last resort, among farm animals. Researchers from the Ohio State University on Monday reported they have found a carbapenem-resistance gene in samples collected from a U.S. pig farm. Carbapenem drugs are not used in agriculture in the U.S. due to their importance as a treatment for people. The identification of this gene in an American farm speaks to the ability of genes and microbes to cross international borders undetected.

The United Nations General Assembly (UNGA) earlier this year came together to tackle antimicrobial resistance and the dire emergency it creates. The only other topics to warrant this action previously were HIV, Ebola, and non-communicable diseases — speaking to the gravity of such an event.

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The outcome was a 15-point declaration outlining global intentions and action items to address this crisis and the three major reasons for the crisis:

1.) Inappropriate use
The more exposure microbes have to antimicrobials, the greater the potential for resistance to develop — so it’s not appropriate to use these medications unless truly necessary. That said, antibiotics are prescribed frequently in the U.S. Often their use is proper. A patient who truly needs an antibiotic should not hesitate to use one.

Abroad, it is often a different story. In many parts of the world, antibiotics that may require a prescription are sold over the counter. This virtually guarantees they will be overused — which has to change.

Antibiotic classes that are used in human medicine (such as tetracyclines) are routinely added to agricultural feed all over the world — and the exposure between bugs and drugs that occurs as a result is astronomical.

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2.) Environmental contamination
This is great concern mostly about industrial runoff from medical manufacturers in countries with lax regulations, and agricultural waste in most developed countries. In India, lakes near the antibiotic manufacturing hub of Medak are noted to be “critically polluted” with antibiotics. This allows bacteria in the environment to be chronically exposed to such antibiotics, which is even worse than inappropriate prescriptions for them. Similarly, trace amounts of antimicrobials can be found in agricultural waste, and the microbes that come in contact with that waste become highly resistant.

3.) Lack of access to health services
This is counterintuitive, though arguably the most important point. The most effective way to reduce antimicrobial use is to prevent the need for it. This involves routine vaccinations, access to sensitive laboratory testing, sterile instruments, and potable water. In other words, it involves access to Western medicine.

Related: Demand for Antibiotics is Over the Top

UNGA specifically called on developed nations to make any new drugs or other control interventions available to the whole world off-patent.

It is no small exaggeration to say that this is an enormous undertaking, or that it will succeed only if there is nearly complete buy-in. It is also no exaggeration to say that this is the only way forward. Microbes do not respect international borders, and what happens in urban India matters a great deal in rural America. Agricultural practices in China can be the difference between a treatable or an untreatable infection in France. It is only by working together that a solution to this crisis can be found. If we fail to do so, we risk reversing much of the medical gains of the 20th century.

Meghan May is an associate professor of microbiology and infectious diseases at the University of New England College of Medicine and is focused on pathogen evolution.

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