Since Sir Alexander Fleming, a Scottish biologist, pharmacologist, and botanist (a 1945 Nobel laureate), first discovered penicillin in 1923, hundreds of more potent wider spectrum antibiotics have been added to the medical armamentarium. These life-saving drugs have been a boon to medical care and benefited hundreds of million patients around the globe.
However, like many good things, antibiotics have been abused by society as a whole, including the medical community. In many cases, they are prescribed without strict medical justification or used for a protracted period, longer than necessary. Individuals who are able to buy them over the counter without prescription use them ignorantly and unnecessarily, without medical rationale. Besides wasting money, they are endangering their health and well-being.
The “Transformer” bugs
Since bacteria have the ability to adapt to substances being repeatedly used against them and mutate (transform itself) overtime to a resistant variety in order to survive, medically resistant strains of the micro-organisms soon develops. They are called superbugs, potential killers which would not respond to any antibiotics at all.
When this happens, humans and other animals would be under the mercy of these superbugs. Medically, we would be transported back to the pre-antibiotic era, where simple wound infection of the hand, arm, or leg could lead to amputation or death, where easy-to-treat bacterial gastrointestinal infection of today could be a frequent killer once more.
Indeed, it is scary to imagine a world with a pandemic of superbugs, without effective antibiotics. People will be dying like flies, especially today when bacteria appear to be more virulent and more adaptive.
Superbugs are here
But this is not science fiction. Today, we already have some superbugs. One of them is the medically resistant tubercle bacilli, where the standard anti-TB regimen is no longer effective and where survival is more of an exception. The more popular one is MRSA, methicillin-resistant Staphylococcus aureus, which used to respond to methicillin, a simpler and much less expensive antibiotic. Today, MRSA is resistant to many antibiotics. In public, most MRSA infections are skin infections, but in medical centers, this dangerous bug causes potentially fatal blood poisoning, pneumonia, and infection of the surgical incisions. MRSA is expected to have a death toll of 19,000 annually in the United States alone.
Luckily for patients with MRSA, Bactrim and Vancomycin, clindamycin, minocycline have been found to be still effective against it. However, resistance is now being seen developing even to some of these more potent and more expensive drugs.
The emergence, multiplication, and spread of superbugs are a threat to the achievements of modern medicine. They would negate and render useless the great advances in pharmacologic science and clinical medicine we have gained so far in our war against bacterial infections.
Warning from WHO
The World Health Organization has published and released its first worldwide review of antimicrobial resistance with data from 114 countries and warning the global community of this serious threat to public health.
WHO assistant director-general for Health Security, Dr. Keiji Fukuda, declared “Without urgent, coordinated action by many stakeholders, the world is headed for a post-antibiotic era, in which common infections and minor injuries which have been treatable for decades can once again kill….the implications will be devastating.”
The report also pointed out that there is a resistance to last resort treatments, like carbapenem antibiotic against the common intestinal bacterium Klebsiella pneumoniae, which has now spread around the globe. This is now ineffective for more than 50 percent of severe infections it used to cure.
E. coli infection of the urinary tract, which used to respond to fluoroquinolones, is now resistant to the drug around the world. When these drugs first came out in the 1980s, there was zero resistance.
The UK, Canada, Australia, France, Japan, Austria, South Africa, Norway, Sweden, and Slovenia have reported treatment failures with third generation cephalosporins, the last resort treatment for the more than one million gonorrhea patients around the world.
WHO also laments the fact that many nations lack basic systems to track and monitor antibiotic use and resistance, and not many have seriously addressed this issue.
Our abuse is haunting us
While bacterial resistance is a natural and expected tendency to a degree, the rapid speed of its development and the number of superbug transformations have been the results of our carelessness and abuse in the use of antimicrobial drugs as a society.
For one thing, viral infections in general (colds, Flu, etc) do not respond to antibiotics, which are actually indicated only for bacterial infections. A person taking antibiotic frequently and without medical supervision is more prone to develop superbugs in his/her body. That would be tragic.
Our abuse, which includes feeding antibiotics to our farm animal sources of meat, could bring back some old enemies in a drug-resistant and deadly form: tuberculosis, typhoid, syphilis, gonorrhea, klebsiella, diphtheria, etc., which could wipe out countless millions more.
Unless people take this warning seriously and act wisely and responsibly, and unless nations around the world work together to reassess and change how these drugs are manufactured, prescribed, and used, and come up with potent new drugs against these superbugs, we, humans, are doomed to lose our war against these deadly bugs. And this could be worse than the plague, known as the Black Death, that killed more than 25 million people (almost half of the population) in Europe in the 14th century.
It’s really up to us.
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Philip S. Chua, MD, FACS, FPCS, Cardiac Surgeon Emeritus in Northwest Indiana and chairman of cardiac surgery from 1997 to 2010 at Cebu Doctors University Hospital, where he holds the title of Physician Emeritus in Surgery, is based in Las Vegas, Nevada. He is a Fellow of the American College of Surgeons, the Philippine College of Surgeons, and the Denton A. Cooley Cardiovascular Surgical Society. He is the chairman of the Filipino United Network – USA, a 501(c)(3) humanitarian foundation in the United States. Email: [email protected]
