The introduction of penicillin was a medical miracle. It unlocked the age of antibiotics, freeing humans from an ever-present risk of fatal infections. Now, less than a century later, bacteria have regained the upper hand.
In 2016, a Nevada woman died of an infection that resisted every antibiotic available to U.S. doctors -- even a last line of defense in infection control, carbapenems. It was among the first documented cases of a "superbug" in the United States, capable of warding off 26 different antibiotics.
While these infections are still rare, they are growing more and more frequent. And that should give us all cause for alarm. Our best drugs are failing us, and the near-term pipeline for new antibiotics is not keeping up. By these measures, we are now living in a post-antibiotic era.
The good news is that we still have time to do something about it. We have the tools needed to avoid a future predicted by the United Nations, where --on the current course -- drug-resistant infections will kill more than 10 million people globally by 2050.
The root problem to address is not drug development, but overuse and misuse.
Microbes are extremely adaptive. It takes generations for them to evolve resistance, but that happens in weeks and years, not eons. Each time an antibiotic is inappropriately administered, we are introducing an evolutionary pressure toward resistance.
Hospitals must act by adopting comprehensive stewardship programs to ensure that antibiotics are used only when needed and at the proper time, dose and duration. Patients also must be educated about the risks associated with antibiotic overuse.
For decades, hospitals administered antibiotics as a precautionary measure when patients were admitted. Though there have been improvements, the U.S. Centers for Disease Control and Prevention estimates that roughly a third of all antibiotics prescribed for infections today remain unnecessary or inappropriate.
To combat this issue, the CDC has identified seven core elements of effective stewardship programs that are now followed by 76% of U.S. hospitals. This number has doubled since 2014 and is a commendable improvement. Yet, we remain off target from achieving a national goal of 100% adherence by 2020. And action domestically will not be enough.
Stewardship programs must also be implemented in coordination with international governments and health agencies. I am proud that earlier this year, the Stanford Antimicrobial Safety and Sustainability program was designated as a World Health Organization collaborating center. This first-of-its-kind designation is intended to strengthen the capacity of nations to implement antibiotic stewardship programs globally.
The public also bears some responsibility. Too often, doctors encounter patients who persistently demand antibiotics despite not needing them. Studies show that, unfortunately, this works. When doctors feel pressure to be responsive, they prescribe more antibiotics. This is especially true at a time when more doctors are being reviewed and rated online by their patients.
We must get ahead of the problem by investing in vigorous public health programs to educate people about the risks of antibiotic overuse. Changing patient behavior will not be easy, but successes with tobacco and seat belts prove that it is possible.
In our evolutionary arms race with bacteria, we need to fight smarter. In large part, that means changing the behaviors that have exacerbated the problem before us. As we enter a period marked by incredible advances in biomedicine, we must not squander the successes and progress we have made by losing sight of an issue that is still within our control.
There is still time for us to prevent our past from becoming the future.
Lloyd Minor, MD, is dean of the Stanford School of Medicine and a professor of otolaryngology-head and neck surgery. This piece originally appeared on his LinkedIn page.
Photo by Paweł Czerwiński
