Can We Fight the Rise of the Superbug?
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And from the perspective of Big Pharma, antibiotic sales—not to mention antibiotic research and development—are simply a losing gambit: Why spend millions of dollars on a product that a person might take once every ten years for no more than ten days, when drugs to lower cholesterol, fight erectile dysfunction or stave off depression are made to be taken daily by millions of people for the rest of their lives?

And yet, our current crop of antibiotic medications is fast becoming obsolete. The insidious, almost sci-fi fact about bacteria is that these bugs can swap genes across species rather than following the ordinary course of slow, generational adaptation by which other organisms are constrained.

The result is that it isn’t just the next generation of a single lineage that becomes drug-resistant, but rather that the discovery of resistance is optimized to happen much quicker—and across vast bacterial populations.

This makes for a very hard target, and we are therefore likely to see a lot more MRSA (methicillin-resistant Staph infection)-type superbugs before this problem is dealt with competently. At the same time, inadequate understanding of when and how antibiotics work has led to abuses of drug intake, such as to incorrectly fight rhinoviruses. Overprescription is also not unheard of. Meanwhile, new household cleaning products and antibacterial soaps flood the market every day to further exacerbate the problem. All of this does not even address the deluge of antibiotics being pumped into our food supply.

MRSA created by medications
When these bugs evolve, producing changes in their genome that leave them no longer vulnerable to antibiotic X (whether that’s methicillin, amoxicillin, penicillin, oxacillin or something else), at some point some portion of the bacterial population is resistant in the presence of the drug. If we then keep bombarding people with antibiotic X, we are in effect selecting for the bacteria that aren’t sensitive to antibiotic X, thereby speeding up the very process of superbug natural selection. We are accelerating the creation of the one bug left standing that nothing can kill.

A bit of welcome news
So it comes as a slight silver lining that a new study published in the British Medical Journal looking into whether the incidence of pneumonia, meningitis, Lemierre’s syndrome and other infections is higher in doctor’s offices that prescribe fewer antibiotics for respiratory tract infections has found only an insignificant increase in cases.

Researchers examined data from over 600 U.K. general practices from 2005 through 2014. Practices in the lowest fourth of antibiotic prescriptions for respiratory tract infections (RTIs) had a "slightly higher" incidence of pneumonia and peritonsillar abscess than those in the highest fourth.

The researchers calculated that if an average-sized practice reduced its antibiotic prescriptions by 10%, it would distribute about 2,000 fewer antibiotic prescriptions for RTIs over 10 years. This would result in just 11 more cases of pneumonia and 1 more case of peritonsillar abscess during the same period.

What’s more, antibiotic prescribing rate was not associated at all with mastoiditis, empyema, meningitis, intracranial abscess or Lemierre syndrome.

The authors conclude: "Even a large reduction in antibiotic prescribing was predicted to be associated with only a small increase in numbers of cases [of pneumonia and peritonsillar abscess] ... and this would be expected to reduce the risks of antibiotic resistance, the side effects of antibiotics, and the medicalization of largely self limiting illnesses."

Still, greater public educational efforts, incentivized R&D and courageous legislative action must all win the day if we are to meet the growing challenge of antibiotic resistance we see today.

BMJ, 2016, Vol. 354,i3410, http://www.bmj.com/content/354/bmj.i3410

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