Ever since I was an graduate student in the 1990s, I have heard warnings of an impending medical crisis – an epidemic of “superbugs” resitant to all antibiotics. I remember being told by a seminar speaker that all of us who would end up working in the pharmaceutical industry would be working on discovering new antibiotics because that would be the top unmet medical need in the near future. But for decades this crisis has always been a few years away, and if anything, the pharmaceutical industry is currently devoting less and less effort to developing new antibiotics.
The idea that this crisis is imminent seems to be becoming more mainstream lately, reaching a general news audience (here and here, for example). The World Health Organization (WHO) recently released a report on the state of antimicrobial resistance worldwide, claiming “a post-antibiotic era – in which common infections and minor injuries can kill – far from being an apocalyptic fantasy, is instead a very real possibility”. And the warnings seem to be becoming ever more dire such as in this article headlined “Superbug threat as grave as climate change, say scientists“.
To be clear, there is no doubt that antibiotic resistance is becoming a greater medical reality every year. The incidences of MRSA and other multi-drug resistant bacteria are more common. But are we really at risk of returning to the state of medicine that existed before the discovery of penicillin, a “post-antibiotic era”?
When I look at the news stories, I see errors in the reporting that tend to exaggerate the problem. One article says, “In some countries half of patients can’t be treated”, which isn’t true as written. (I think this is a misinterpretation of the finding that in some areas, half of the infections by a certain type of bacteria can’t be treated with one common class of antibiotics.) Another article reports that 19000 people die in the United States each year due to infections by resistant bacteria, but that can be misleading without the context of how many of those people would have died even if the infection weren’t resistant (many people die each year due to infections by non-resistant bacteria, so a meaningful discussion would include a comparison between these two groups). So my generally impression that the issue is being over-hyped in the news media.
But regardless of how serious the problem is, an organized response from the medical community worldwide is needed. Local solutions will be insufficient. So it’s good to see that an international organization like the WHO is making a serious effort at evaluating the problem and aiming to create a framework for a global response. One aspect of the response will be to encourage judicious and appropriate use current antibiotics in order limit or slow down the development of resistance. The other aspect will have to be development of new antibiotics, which I’ll write about shortly…