5 Ways a Post-Antibiotic Era Could Change Medicine
For the first time ever, this month the United Nations General Assembly convened a high-level meeting on the topic of antibiotic resistance. At the meeting in Geneva, members committed to develop action plans to reduce antibiotic use.
The urgency for this rare meeting stems from news over the last few months, when we've seen the emergence of resistance to the antibiotic colistin in humans and pigs in the U.S. Colistin, an old drug, is one of our “last resort” antibiotics. Physicians have been reluctant to use it because it can be toxic, and because of their restraint, resistance to the drug hasn’t historically been much of an issue in people. But while its use was rare in the U.S., it was commonly used in agriculture in China. Resistance genes ended up on a plasmid (a piece of DNA that can “jump” between bacteria species) and due to travel and trade, is now in the U.S. This is alarming, as once resistance to an antibiotic evolves, we know it can spread very quickly.
Colistin resistance is far from our only problem. There are now many common bacteria already resistant to antibiotics or carrying a resistance gene that may jump between other bacterial species. Antibiotic resistance leads us to a cornucopia of abbreviations: MRSA, VRE, NDM-1: bacteria that are resistant to antibiotics (methicillin-resistant Staphylococcus aureus; vancomycin-resistant Enterococci) or carry a resistance gene that can jump between bacteria species (NDM-1), like the colistin resistance gene can (abbreviated MCR-1). Even gonorrhea infections are becoming untreatable. A report released earlier this year suggests that by 2050, antibiotic-resistant infections will kill more people each year than cancer.
The bottom line is that we’re losing our last effective antibiotics, and it will change the way medicine is administered in the future.
It can be hard to visualize the enormous impact antibiotic resistance will have, so here are five ways antibiotic resistance might change your life.
1. A SCRATCH COULD BECOME DEADLY.
Infectious disease journalist Maryn McKenna wrote about her great-uncle’s death at age 30, in 1938, five years before antibiotics became widely available. “Through one of the scrapes, an infection set in. After a few days, he developed an ache in one shoulder; two days later, a fever. His wife and the neighborhood doctor struggled for two weeks to take care of him, then flagged down a taxi and drove him fifteen miles to the hospital in my grandparents’ town. He was there one more week, shaking with chills and muttering through hallucinations, and then sinking into a coma as his organs failed. Desperate to save his life, the men from his firehouse lined up to give blood. Nothing worked.”
Though this was 80 years ago, this scenario could become common again. As the available drugs fail, any breach of the skin could once again result in a deadly, untreatable infection. Something as simple as gardening or getting a tattoo could be fatal.
2. MINOR ILLNESSES WON'T BE MINOR ANYMORE.
Infectious disease physician and researcher Eli Perencevich tells mental_floss, “The post-antibiotic era will be your sister or mother dying of a urinary tract infection or your brother dying of a simple appendicitis. But I can't offer a description of life cut short quite like Alfred Reinhart’s death."
As a medical student at Harvard, Reinhart had survived a bout of rheumatic fever at age 13, leaving him with a chance of developing rheumatic heart disease later in life. He was also concerned about the potential to develop a bacterial infection in his heart—which he tracked by keeping close watch on his own symptoms during his time in medical school. He meticulously documented his irregular heartbeats, heart murmurs, and faint skin rashes for months, telling his own doctors he was going to die. He continued to take notes on himself until two days before his death at age 24 from subacute bacterial endocarditis following rheumatic fever.
"Both conditions would be prevented or treated with antibiotics only a few short years later,” Perencevich says.
3. SURGERY WOULD BECOME NEARLY IMPOSSIBLE.
Even now, infections occur after 1 to 3 percent of surgeries. Most of these are still treatable with antibiotics, but about 3 percent still lead to death. Even surgeries many consider “routine” now could easily become complicated without antibiotics, such as Caesarean sections or knee replacements. Infectious disease physician Judy Stone tells mental_floss, “Joint replacements, which are now routine, would be enormously risky. Without effective antibiotics, 40 to 50 percent of patients undergoing hip replacement would develop infections, and approximately 30 percent would die.”
Something like a bone marrow or organ transplant, where the host’s immune system must be compromised to accept the new tissue, would no longer be possible at all; the risk of an untreatable infection would be too high. Stone notes this trend has already started. “I already regularly see men who develop sepsis following prostate biopsies," she says. "They are routinely given Cipro as antibiotic prophylaxis by their urologist, and the bacteria causing their bloodstream infections are now often resistant to Cipro.”
And “elective” surgeries, such as most cosmetic procedures? Forget about it.
4. ANTIBIOTICS COULD BE RATIONED OR ONLY AVAILABLE TO THOSE WITH MEANS.
It may sound far-fetched, but we’ve seen in recent months how easily critical medicines—EpiPens, insulin, treatments for HIV-associated infections, even acne creams—can quickly become financially out of reach. Because antibiotics are “community drugs”—use in anyone can affect how well they work in the whole population—as we find ourselves with fewer and fewer options available for treatment, the few remaining drugs may become strictly rationed—and expensive.
5. IT'S ALREADY HAPPENING.
In many developing countries, deaths from antibiotic-resistant infections are already far too common. In 2015, approximately 1.8 million people died of tuberculosis—in part because drugs weren’t available, and in part because their drugs did not work.
The grandfather of antibiotics, Alexander Fleming, famously predicted in his speech for the 1945 Nobel Prize in Physiology or Medicine, which he received for his discovery of penicillin, that in the future, penicillin might be misused and rendered ineffective. He was all too correct. By 1950, 40 percent of Staph bacteria found in hospitals were already resistant to penicillin.
Now, we have an almost impossible task ahead of us—to preserve the antibiotics we still have by using best prescribing practices in hospitals and clinics, reducing unnecessary use in livestock, and working to develop novel ones before it’s too late.