Take Antibiotics Only if Necessary

A new drug may be approved this year that could change the landscape on antibiotic-resistant bacterial infections.

Carbavance, viewed as a breakthrough antidote for carbapenem-resistant enterobacteriaceae, or CRE, is expected to be filed for new drug approval at some point this year. Carbavance could significantly reduce a mortality rate that currently hovers around 50 percent for these infections, according to Medical Marketing and Media.

So-called superbugs such as CRE are not new germs. They just have more armor, thanks in part to the over-use of antibiotics that has rendered them continuously less effective against ever-evolving germs.

The Centers for Disease Control reports that 2 million people in the U.S. develop antibiotic-resistant infections every year — and that 23,000 of those die from their infection. This highlights the urgency of figuring out a response to antibiotic-resistant bacteria.

“We never used to give kids antibiotics,” said Joanne Tierney, 81, a Worcester, Massachusetts, mother of 2 and grandmother of 5. “Antibiotics were saved for dire cases, not routinely handed out for every illness. Today, they (the doctors) seem to over-prescribe.”

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Before the introduction of penicillin, there was no effective treatment for infections like rheumatic fever, gonorrhea or pneumonia. The idea of hospitals in the past clogged with patients who had gotten a minor cut or scratch and developed blood poisoning reminds us that penicillin was truly a remarkable discovery.

That was then. Today, are we at risk from so-called antibiotic-resistant “superbugs”?

“Back in the ’20s and ’30s when penicillin was first used, there was a sort of hubris in the medical community that announced, ‘We have conquered infections,’” said Dr. Frank Esper, pediatric infectious disease specialist at University Hospital’s Rainbow Babies & Children’s Hospital and assistant professor of Pediatrics at Case Western Reserve School of Medicine.

“There are now infections I see in the hospital that I can’t treat because the bacteria is resistant to everything I have available. The patient dies.”

“Today, we understand it’s much more complicated than that. The media has used the term ‘superbug,’ which is a bit misleading — the germs themselves haven’t changed, they just have more armor now. Germs learn how to be more and more resistant as they are exposed repeatedly to antibiotics.”

Resistance occurs organically in germs, and they mutate at random. But if germs are students, antibiotics are their teachers, showing germs how to respond — and therefore evolve. The more exposure to antibiotics, the smarter the germs become.

“It’s a problem that’s only going to get worse with time,” said Esper. “I like the analogy of a tennis match. Doctors serve up a new antibiotic, and germs volley back a new mutation, resistant to that medicine. So we volley back another medicine, and they hit back at us with yet another resistance. The problem is, we have less antibiotics now to volley back to them.”

The reason for the lack of new antibiotics? Money and “big pharma.”

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“The business model for them has changed,” says Esper. “Pharmaceutical companies are getting out of antibiotics, which are prescribed for short durations. Big Pharma doesn’t make money curing disease; they make money on drugs that people stay on for years and years throughout a lifetime.”

“We can’t treat infections,” Dr. Barbara Murray, past president of the Infectious Diseases Society of America and co-director of the Center for the Study of Emerging and Re-Emerging Pathogens at UT Health in Houston, told Vice.com. “There are now infections I see in the hospital that I can’t treat because the bacteria is resistant to everything I have available. The patient dies.”

Esper related a three-pronged approach to dealing with antibiotic resistance in public health:

1: Practice good antibiotic stewardship.
“If we can slow germ progression by slowing the exposure to antibiotics, that will be key,” said Esper. “Hospitals should also decrease the use of high-powered antibiotics and opt for simpler ones. Lessening duration of antibiotic treatment is also helpful. And very importantly, we need to reduce use of antibiotics in farm animals; this is a huge factor in decreasing germ resistance.”

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2: Limit exposure from person to person and place to place.
“Infection control is key,” Esper said. “Contact perpetuates the spread of germs and illness.” Indeed, most bacterial infections are spread in hospitals, where already sick patients are exposed to a variety of germs.

3: Make better antibiotics.
“If antibiotic-resistant germs are playing tennis with us, we need to get better rackets,” said Esper. “We need more types of antibiotics, more sophisticated and just plain better antibiotics. While Big Pharma may not be interested in developing new antibiotics, smaller pharmaceutical companies certainly are. The National Institutes of Health offers huge incentives for antibiotic creation. The government needs to increase the funding to smaller companies to research potential new drugs, and make them available to the public.”

Many doctors are more careful about prescribing antibiotics today. Allison Kelly Fusco, a Boston-area mom, told LifeZette, “I notice that my children’s pediatrician will look back and see when my child has been on an antibiotic last, and they will take that into consideration before prescribing. I do understand and support using antibiotics if there is no other option.”

Esper feels optimistic about a coalition of efforts to combat antibiotic-resistant infections. “With good policy, good education and good stewardship, we can increase antibiotic effectiveness and effect better patient outcomes.”