D-Day: The Battle to Save the Antibiotic Era has been Joined

April 13th, 2015

Antibiotic stewardship to rein in the rampant misuse and overuse of drugs – practices which continue to select out resistant, even pan-resistant strains of bacterial pathogens -- has officially become a national priority involving the highest levels of the federal government. It’s about time – and we don’t have much of it.

The modern antibiotic era began a mere 75 years ago with the use of penicillin in WWII, ending the long reign of pestilence and cheating death of millions of patient lives. Now clearly at risk of squandering a medical miracle -- through indiscriminate use that has aided and abetted bacterial adaptation and evolution – we have finally, as a nation, drawn a line in the petri dish.

Future historians may mark March 27, 2015 as the “D-Day” when the nation began an unprecedented effort to push back the encroaching post-antibiotic era. It marks the release of a battle plan of sorts -- the “National Action Plan for Combating Antibiotic-Resistant Bacteria.” The White House plan sets ambitious infection reduction goals, using a combination of regulations, penalties, and incentives to force all acute care hospitals to establish antibiotic stewardship programs. While hospitals are the first target, antibiotic stewardship programs are expected to be required eventually for a broad spectrum of outpatient and long term care settings. The stakes are high.

“[We] can no longer take for granted quick and reliable treatment of rare or common bacterial infections, including bacterial pneumonias, foodborne illnesses, and healthcare-associated infections,” the national plan states. “As more strains of bacteria become resistant to an ever larger number of antibiotics, we will also lose the benefits of a range of modern medical procedures—from hip replacements to organ transplants—whose safety depends on our ability to treat bacterial infections that may arise as post-surgical complications.”

Indeed, in some cases the post-antibiotic era has already arrived, as clinicians report patient deaths from once survivable infections that no longer respond to antimicrobial therapy. What would it be like to go back to the pre-antibiotic era? Consider the case of a 9-year-old mischievous girl who decided to miss a few school days by rolling around in a patch of poison ivy.¹ The ruse worked, but she scratched her legs so much her skin opened in places, allowing bacteria easy access to enter and multiply. Unfortunately, the year was 1934 and the mortality rate for skin infections was in the 11% range. She survived, but was still telling the cautionary tale decades later as a grandmother.

Infections of the skin and just about any other body site have been treatable for so long, we have taken the relatively brief span of the antibiotic era for granted.

Not anymore.

Reference

1. Koerth-Baker, M. Raiding Grandma’s Medicine Cabinet. New York Times April 16, 2013: http://nyti.ms/1DWULb6