Medicine without antibiotics
Io9.com continues to be my favorite site for science related news alerts, plus spoiler containing updates for Doctor Who and Game of Thrones. A very nice summary of what medicine might look like in the near future was published today, as we enter the “post-antibiotic era.” BIO230 students have often been treated to my dire warnings about how we will increasingly be faced with patients who do not respond to standards of treatment for infectious diseases. The article states that antibiotic resistant infections currently add about $30 billion dollars to US health care costs annually, and this figure is expected to continue to increase. As cited in the Guardian, medical conditions that we can expect drastic changes in the very near future include:
• Transplant surgery becomes virtually impossible. Organ recipients have to take immune-suppressing drugs for life to stop rejection of a new heart or kidney. Their immune systems cannot fight off life-threatening infections without antibiotics.
• Removing a burst appendix becomes a dangerous operation once again. Patients are routinely given antibiotics after surgery to prevent the wound becoming infected by bacteria. If bacteria get into the bloodstream, they can cause life-threatening septicaemia.
• Pneumonia becomes once more “the old man’s friend”. Antibiotics have stopped it being the mass-killer it once was, particularly among the old and frail, who would lapse into unconsciousness and often slip away in their sleep. Other diseases of old age, such as cancer, have taken over.
• Gonorrhea becomes hard to treat. Resistant strains are already on the rise. Without treatment, the sexually transmitted disease causes pelvic inflammatory disease, infertility and ectopic pregnancies.
• Tuberculosis becomes incurable – first we had TB, then multi-drug-resistant TB (MDR-TB) and now there is XDR-TB (extremely drug resistant TB). TB requires very long courses (six months or more) of antibiotics. The very human tendency to stop taking or forget to take the drugs has contributed to the spread of resistance.
Options left to reverse these dire trends are limited. Possibilities described in the io9 article include the development of novel antibiotics, use of bacteriophages to combat bacterial infections, and the use of vaccines to prevent infections in the first place. The first choice (antibiotic development) does not really represent a true fix for this problem, as the use of any new antibiotics will lead to resistance of microorganisms to those new antibiotics, likely within a relatively short time frame. The only truly effective “fix” to this situation is to change how we use antibiotics in the first place.