The Future of Antibiotics

This is the last in my weekly antibiotics updates.  I hope you enjoyed them.

The enormity of our love affair with antibiotics is staggering...we currently use over 7 million pounds per year of antibiotics for humans and over 26 million pounds per year for animals destined for the food chain, and this, nearly 60 years after Alexander Fleming issued numerous warnings that we should be diligent in unleashing antibiotics into the environment to prevent resistance from spreading.

In its recent annual report on global risks published in the New England Journal of Medicine in 2013, the World Economic Forum concluded that:

“Arguably the greatest risk … to human health comes in the form of antibiotic-resistant bacteria. We live in a bacterial world where we will never be able to stay ahead of the mutation curve. A test of our resilience is how far behind the curve we allow ourselves to fall.”

Whether we can continue to develop new antibiotics ahead of the resistance curve  is anyone’s guess.  Microbes develop resistance to synthetic antibiotics just as readily as they do natural ones.  Once a single microbe becomes resistant to an antibiotic, it’s new purpose in life is to transfer that knowledge to every microbe it comes in contact with.  There is no end to the number of antibiotics a microbe can be resistant to, why should there be?  They invented the concept 4 billion years ago. Microbes have had, literally, “forever,” to develop a defense against anything that may end their existence.

Theoretically, antibiotic resistance to a particular antibiotic should be limited to the small geographic area where the antibiotics were administered, as in a hospital setting or home. In this modern age of mass transportation and centralized “hunting and gathering” our lives have become intricately intertwined so that an antibiotic sends ripples that cross the nation and the world. Add to the complexity that it’s not just antibiotics given for life-saving measures, but inappropriately dosed antibiotics and antibiotics consumed in our food supply and you quickly see the enormity of the problem.

 If antibiotics were banned from animal use and limited in humans to saving lives only, antibiotic-resistant infections would still occur, but the spread of resistance would be slowed considerably. But, ultimately, whether it takes years, decades, or centuries antibiotics will one day become obsolete.

One proposal for the future of antibiotics lists a five prong plan of attack:

1. Prevent infections from occurring in the first place
2. Encourage new economic models that spur investment in anti-infective treatments
3. Slow the spread of resistance in order to prolong the useful lives of antibiotics
4. Discover new ways to directly attack microbes in a manner that does not drive resistance, (such as defensins and AMPs)
5. Alter host–microbe interactions in order to modify disease without directly attacking microbes

 

You have to wonder what Alexander Fleming and Selman Waksman would say.  Would they approve of what is happening with the antibiotics they so lovingly pried from the dirt and nurtured?  Would they think we squandered their gifts and the hope that mankind would be forever free from the grip of pathogenic microbes? What would they think of the indiscriminate prescriptions written as cures for non-bacterial illness, the feeding of antibiotics to healthy animals destined for our dinner plate, and the Frankenstein like creation of synthetic antibiotics created completely by a computer?

Will we once again know the agony that comes with widespread death and disfigurement as the cholera and yellow-fever epidemics brought?  Will minor scrapes and cuts mean a possible death sentence as they once did?  Or will science overcome these hurdles?

Everyone reading this can do themselves (and the world) a favor.  Ensure you have the healthiest set of gut microbes possible...eat to feed them and ingest a continual supply of new microbes to keep diversity high.  Refuse to support a livestock industry that relies on antibiotics to fatten it’s animals.  Only accept antibiotics as a last resort and ask for non-antibiotic interventions where possible.  

In this delicate ballet of life, balance must be struck.  Our modern lifestyle stacks the deck against us, the microbial inhabitants of our bodies should serve as a first line of defense against disease, but instead they have become a cause of disease.  The targeted use of probiotics and eating a diet to support gut microbe diversity swings the balance back in our favor.  Reclaiming ancient traditions such as heritage farming practices and preserving foods as we did in the past can help to replenish the ancient allies which we have lost over the last 50-70 years.


In ‘act 2’ of man’s reign on Earth, we must return to a reliance on the very microbes that saw us through millions of years before science, as difficult as that will be for modern thinking men.