DR. ARVIND DHOPLE: Tipping Point on Infection Resistance to Antibiotics, Now Global Emergency

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Misuse and overuse of antibiotics have contributed to antibiotic resistance

ABOVE VIDEO: Center for Disease Control and Prevention highlights the key points and graphics of their report on the real threat posed by rapidly emerging antibiotic resistance in the U.S.

EDITOR’S NOTE: Resistance to antibiotics amongst organisms causing infections is now a global emergency.

Since the 1940s, antibiotics and similar drugs, together called antimicrobial agents, have been used to treat patients with infections, and have greatly reduced illness and death from infectious diseases. When prescribed and taken appropriately, the value of antimicrobial agents to combating complications and death from infections is prodigious. However, these drugs have been used so widely for so long, and often times inappropriately, that the infectious organisms the antibiotics are designed to kill have adapted to them and become resistant, making the drugs less effective.

Antibiotic resistance is a type of drug resistance in which a genetic change results in a microorganism becoming able to survive exposure to an antibiotic.

Antibiotic resistance is a type of drug resistance in which a genetic change results in a microorganism becoming able to survive exposure to an antibiotic.

We are delighted to once again welcome Arvind M. Dhople, Ph.D., Professor Emeritus, Florida Tech as a guest columnist to share his thoughts and latest developments that address integrative approaches to dealing with the critical problem of antibacterial resistance.

With antimicrobial drug resistance occurring everywhere in the world and not limited to industrialized nations, Dr. Dhople strongly supports the immediate action to more aggressively and comprehensively address this crisis.

– Dr. Jim Palermo, Editor-in-Chief

BREVARD COUNTY, FLORIDA – Scientists say the evolution of disease will “creep up on us insidiously,” and they warn that resistance of disease to antibiotics has reached a “tipping point” at which it would creep into the developed countries like the United States, the United Kingdom, etc., almost without notice.

They predicted that the effects would be gradual and would be seen not just in resistant new infections but also in everyday medical practice, and the treatment of everything from diabetes to minor wounds at risk of turning septic.

Antibiotics and similar drugs, together called antimicrobial agents, have been used for the last 70 years to treat patients with infectious diseases. Since the 1940s, these drugs have greatly reduced illness and death from infectious diseases. However, antimicrobial agents have been used so widely, not only in medicine, but also in agriculture and veterinary practice, for so long that the infectious organisms that the antibiotics are designed to kill have adapted to them, making the drugs less effective, and in some cases totally ineffective.

Each year in the United States, at least 2 million people become infected with bacteria that are resistant to antibiotics, and at least 23,000 people die each year as a direct result of these resistant infections.

Globally, infections from common bacteria resistant to antibiotics, such as Methicillin Resistant Staph Aureus (MRSA) and Clostridium difficile result in thousands of deaths and millions of dollars in healthcare costs annually.

These “Superbugs” are estimated to cause 700,000 deaths every year. If the current situation is left to continue, it is estimated that my 2050 the world will face an additional 10 million deaths due to drug-resistant infections.

According to the Centers for Disease Control and Prevention (CDC), at least two million people in the United States become infected with bacteria that are resistant to antibiotics. Statistics also show that 23,000 people die as a direct result of those infections.

This is not the sort of contagion such as a circumstance in which a person from Hong Kong travels to New York carrying an unusual bacterium or virus that is emerging and that we have all feared. Antimicrobial resistance creeps insidiously, and of course, that is in many ways more difficult to cope with.

Drug resistance is a bacterial adaptation to the antibiotics designed to kill them, making our antibiotics less effective and limiting our treatment options. Infections from resistant organisms can be difficult to treat and often require costly and sometimes toxic alternatives to which the bacteria have not yet developed resistance.

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There was a “golden age” of antibiotics, but complacency and overuse of many antibiotics set in during the 1970s and 1980s when there should have been more prudent utilization of existing antibiotics and more of a focus on preventing resistance.

Twenty years ago there were 18 reputable companies in the commercial sector working in the field of new antibiotic research and development, but now due to a variety of mostly economic factors dominated by the fact that profits dwindled as gener­ics dom­i­nated treat­ment, there are just four. Consequently, only five new classes of antibiotics have emerged in the past 10 years.

The healthcare community and policy-makers should call for more imaginative ways to incentivize the pharmaceutical industry to invest in an­tibac­te­r­ial and an­tivi­ral re­search pro­grams, such as through changes to patents, and the easing of regulation around clinical trials.

The prudent use by clinicians of antibiotics is imperative to help quell the threat of ongoing antibiotic resistance. Patients and doctors should work together because incorrectly prescribed antibiotics contribute to the promotion of resistant bacteria, have a questionable therapeutic benefit and expose patients to potential complications of antibiotic therapy.

Access to antibiotics should also be better regulated to avoid their rampant overuse, especially in underdeveloped countries where in many cases antibiotics can be purchased over the counter at low cost with no requirement for healthcare professional assessment as to the true need for the drug. Rapidly emerging antimicrobial drug resistance is a global problem, the solution for which cannot lie with one country or even a handful of countries.

Last year an international group of scientists and physicians described what they called an “apocalyptic scenario” where people going for simple operations in 20 years’ time could die of routine infections “because we have run out of antibiotics.”

Recall the impact of HIV as an example of when infectious disease emerges that has no antibiotic for it. It is etched on our minds 30 years later. Younger people, predominantly male that time, coming in and dying within days, weeks and months of their infections because we had no way of treating it.

I am not presenting the crises in apocalyptic terms, yet. However, we are definitely approaching a “tipping point.” The Centers for Disease Control and Prevention (CDC) has classified a number of bacteria as presenting urgent, serious, and concerning threats, many of which are already responsible for placing a substantial clinical and financial burden on the U.S. healthcare system, patients, and their families. Coordinated efforts to implement new policies, renew research efforts, and pursue steps to manage the crisis are greatly needed. 

Dr. Arvind Dhople is currently Professor Emeritus at Florida Tech and a free-lance writer.

ABOUT THE AUTHOR

Dr. Arvind Dhople graduated from the University of Bombay and then joined Johns Hopkins University School of Public Health, first as a postdoctoral fellow and then Asst. Professor. In 1980, he joined Florida Tech as a Professor and Director of their Infectious Diseases Lab. His specialty is microbial biochemistry and he performed research in leprosy and tuberculosis. He is a Fellow of the American Academy of Microbiology and has published nearly 150 articles in peer-reviewed journals. He has also served as an advisor to the World Health Organization, National Institutes of Health, German Leprosy Relief Association, and the Bill and Melinda Gates Foundation. Currently, he is Professor Emeritus at Florida Tech and a free-lance writer. 

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