If bacteria had a motto, it would be "What doesn't kill us makes us stronger." In an environment of low-dose antibiotics, the few organisms that may be resistant to the drugs will suddenly flourish when their competitors die off and pass on the resistance to their descendants. Just one of these potential superbugs, reproducing every 30 minutes, can become 1 billion--in a day.
That's the challenge President Barack Obama hoped to address with the release in March of the National Action Plan for Combating Antibiotic-Resistant Bacteria, a five-year program to take on antibiotic resistance. This is a solid course of action, yet it has one major flaw that threatens its enormous good.
Not long ago it might have seemed like infectious diseases could be conquered. With modern sanitation, good hygiene and what appeared to be the magic bullet of antibiotics, many of the former bacterial scourges of humanity appeared to have been defeated.
But bacteria are implacable foes and they never, ever stop evolving. The discoverer of penicillin, Alexander Fleming, warned of the dangers of antibiotic resistance in his Nobel Prize address in 1945. His fears have come to pass.
The U.S. Centers for Disease Control and Prevention estimated in its landmark 2013 report that "Each year in the United States, at least two million people acquire serious infections with bacteria that are resistant to one or more of the antibiotics designed to treat those infections. At least 23,000 people die each year as a direct result of these antibiotic-resistant infections. Many more die from other conditions that were complicated by an antibiotic-resistant infection."
The agency noted that health care and productivity costs from this devastation could reach $20 billion and $35 billion, respectively.
Antibiotics are one of the greatest discoveries in medicine. But we're losing the effectiveness of these magic bullets, and we're in danger of wiping out their powers entirely. Indeed, the CDC and World Health Organization have each said that if we don't rein in antibiotic use in all settings, we will soon be living in a post-antibiotic world. If this doesn't alarm you, then you haven't visualized life without antibiotics. This will change everything from how it feels to touch the hand rail on an escalator to the procedures doctors can safely perform in the hospital.
The president's comprehensive new plan takes many encouraging steps. It offers practical measures for improved stewardship of antibiotic usage in human medicine, along with time-bound, measureable goals for reductions. It will strongly enhance the sorely needed data collection process, help speed the development of new antibiotics, and encourage rapid diagnostics to enable faster response and treatment.
The one area of concern lies with animal agriculture. The president's plan offers no measurable goals for antibiotic reductions in food-animal production and, most importantly, no practical steps for tackling antibiotic use for routine disease prevention.
Imagine a pipeline of toxic sludge flowing into a lake from which you draw water. You want to protect the water source so you work to reduce the size of that pipe's flow, which means, in this analogy, reducing the 9 million pounds of antibiotics used in human medicine every year. Truly, there's room there to make an impact. But meanwhile, a second much bigger pipe continues to pump sludge unregulated, with the most recent data showing over 32 million pounds of antibiotics sold for use in animal agriculture in 2012.
Most of these drugs are used to make animals grow faster and for routine disease prevention. Fortunately, after decades of delay, the Food and Drug Administration last year took steps to address this issue by releasing a voluntary guideline to eliminate antibiotic use for growth promotion purposes.
But growth promotion accounts for less than 15 percent of the stated use of these drugs. By far the larger share goes to trying to compensate for the overcrowded, dirty conditions in which so many food animals are raised. This is unacceptable. If concentrated animal feeding operations routinely create sick animals, the answer isn't to give the animals antibiotics to prevent these infections. The answer is to change the system.
We can't wait that long, however. The U.S. Food and Drug Administration should take additional steps to address the rampant overuse of antibiotics in food animal production by acknowledging that, along with growth promotion, routine disease prevention is also inappropriate. The agency should move to immediately end these uses.
The president's plan to combat antibiotic resistance is a major leap forward in tackling a serious and growing problem. But now we need to find additional avenues of controlling the irresponsible flood of antibiotics into animal agriculture that undermines their effectiveness in human medicine.
Lance B. Price is a microbiologist and professor at the Milken Institute School of Public Health, George Washington University, and at Translational Genomics Research Institute.
Editorial on 04/19/2015