January 23, 2018
A Post-Antibiotic Future?
Be Well

A Post-Antibiotic Future?

by David Tuller, DrPH

In its first report on the global state of antibiotic resistance, the World Health Organization (WHO) is propounding a terrifying message: Resistance to a growing range of medications has reached alarming levels in many parts of the world, and we are rapidly approaching a post-antibiotic future in which many people will die from the kinds of illnesses and injuries that we are used to treating successfully.

The report is not surprising, of course. In the U.S., public health agencies, health care providers, advocacy groups and medical organizations have for years been issuing increasingly urgent warnings about the proliferating pace of antibiotic resistance; researchers have been uncovering the ingenious ways devised by bacteria to share antibiotic resistance genes with other species. The Food and Drug Administration (FDA) has taken a few steps, however feeble, to rein in the agricultural abuse of antibiotics as a promoter of livestock growth, given that animals in the U.S. are estimated to consume 80 percent of the drugs.

Yet the WHO report, issued last month, brings a global lens to this sobering problem. “Unless we take significant actions to improve efforts to prevent infections and also change how we produce, prescribe and use antibiotics, the world will lose more and more of these global public health goods and the implications will be devastating,” said Keiji Fukuda, M.D., M.P.H., WHO’s Assistant Director-General for Health Security, in a statement.

Among the report's scary highlights:

  • In 2012, there were almost half a million new cases of multidrug-resistant tuberculosis, and a more severe version known as extensively drug-resistant tuberculosis has been found in almost 100 countries.
  • Austria, Australia, Canada, France, Japan, Norway, Slovenia, South Africa, Sweden and the United Kingdom have all seen cases of gonorrhea resistant to third-generation cephalosporins, the antibiotics of last resort.
  • In many countries, fluoroquinolones that have been used for decades to treat common urinary tract infections caused by E. coli are now ineffective in more than 50 percent of patients.
  • Resistance to carbapenem antibiotics—the treatment of last resort for many hospital-based infections caused by an intestinal bacteria, Klebsiella pneumonia—has now become global.

Given the scale of the problems, the suggested solutions—more focus on preventing infections in the first place, better global coordination and tracking of the spread of resistance, promotion of proper antibiotic use and better diagnostics and other tools to help health care providers reduce their need to prescribe antibiotics—seem tepid at best. The tools we take for granted to keep ourselves safe are rapidly losing their ability to protect us—and we’ve got very little in the pipeline to replace them.