OK! Read the article. And then read the editorial and another article that's more worthy of the click-bait headline than this one. (From a microbiology standpoint it's really interesting tho.) And then another article that exemplifies the reason this isn't going to kill us all even tho it causes problems. All in the same issue of Lancet Infectious Disease, which was specifically organized for World Antibiotic Awareness Week last week. I'll briefly review all of the articles I mentioned .
The problem's the same as it's always been, this is a new development but not a disaster, and I am unimpressed with the BBC's science journalism on this one.
So here's the link to the editorial from last month http://www.thelancet.com/journals/lanin ... 1/abstract
All Lancet links are paywalled, I'm including them anyway because you can at least see the abstracts or the intro, and since anyone who's a student may have access thru their university.
More importantly, here's the link to the WHO report on the state of antibiotics which is a huge doc and long to load but free! http://cddep.org/publications/state_wor ... otics_2015
The first paper! The original one Raptor posted.
So, colestin from the family of antibiotics that includes bacitracin and polymyxin (2 of the things in neosporin, neomycin's the other.) It's got some fairly lousy side effects (tries to kill your kidneys) so it's not used internally for people EXCEPT for some situations with multi-drug resistant bacteria (pseudomonas, klebsiella). Basically it's not a great drug exactly but sometimes it's the only one left that a bacteria is sensitive too.
Bacteria have things called plasmids that they can transmit to each other by conjugating (think of this like having kids with 2 parents instead of just cloning themselves like they usually do) which increases their genetic diversity. A plasmid gene encoding for colestin resistance is now becoming much more common. The agricultural use of colestin is actually highly relevant here because the human use is almost nil - only in very ill patients when nothing else is working. Remove any evolutionary pressure that favors that plasmid, and the spread becomes slower and much more random. Constantly keep killing lots of bacteria that aren't resistant to colestin and all of a sudden this gene becomes the norm. So feeding it to cows to help them put on extra weight for market, etc? Basically the cause of this particular problem. It may seem hipster but antibiotic-free meat/dairy has a point.
Yes, if you have MDR pseudomonas this is maybe a problem but the vast majority of pseudomonas (and klebsiella) are not MDR (multi-drug resistant).
There's a "Comment" (basically a short editorial) accompanying the article, which does state :
In 2012, WHO reclassified colistin as critically important for human medicine.8 This classification remains true despite the ongoing development of new antibiotics against multiply resistant Gram negative bacilli. There have been previous calls for curtailing the use of polymyxins in agriculture.9 We must all reiterate these appeals and take them to the highest levels of government or face increasing numbers of patients for whom we will need to say, “Sorry, there is nothing I can do to cure your infection”.
(Online only, I can't get link without going thru my university access)
Now, the second paper and comment! Abstract http://www.thelancet.com/journals/lanin ... 1/abstract
Comment : http://www.thelancet.com/journals/lanin ... 5/abstract
Some epidemiology folks took what data there is for rates of cancer treatment related infections and surgical site infections for procedures where we give antibiotics to prevent infection after chemo or surgery (eg joint replacements, appendixes, colon removals, cesarean sections). They then looked at the rates of resistance of the bacteria likely to cause each of those infections, and how many of kinds of those procedures are done in the US each year, and then projected how many additional surgical infections and how many additional related deaths we would see if resistance rates increased by 10%, 20%, 30% etc. They found that if : (from the accompanying comment)
They conclude that a 30% reduction in the efficacy of surgical and oncological prophylaxis would be disastrous, resulting in an additional 120 000 surgical site infections and 6300 infection-related deaths in the USA every year.
Now, that's Not Good. A 30% increase in resistance is not out of the ballpark especially if nothing changes. Bad for the people involved and costly to a health care system that's already straining the limits of its budget. But not "the post-antibiotic era" either.
One mitigating factor however, is going to be looking at how many of those surgeries we actually have to do. The cesarean rate in this country is demonstrably higher than it ought to be for the health of moms&babies. We do a TON of knee replacements, some of which we could delay or perhaps prevent with other measures. That would not 'fix' a situation like the one being modelled, but it would ameliorate it somewhat.
In the same issue, a third article and comment that demonstrates what kind of change it can take to bend this curve for the better: (still paywall but) Comment :http://www.thelancet.com/journals/lanin ... 3/abstract
Article abstract : http://www.thelancet.com/journals/lanin ... 1/abstract
Quote from the comment, about the results of a nationally funded Scottish program for AntiMicrobial Stewardship [AMS].
Next, restrictive measures were used, including removal of targeted antibiotics from ward stock and requiring of authorisation for use from an infectious diseases expert. We and others have suggested antibiotic release by experts in AMS as a way to ensure appropriate use of our antibiotic resources.5 and 6 This approach not only resulted in an abrupt and permanent reduction in targeted antibiotic hospital use within 4 months of implementation, but also led to a gradual, but permanent, reduction in community use of antibiotics.1 Notably, hospital-based interventions were indirectly associated with a 32% reduction in community MRSA infections. Furthermore, AMS in primary care was estimated to have prevented more than 3000 community MRSA cases. This raises the question of whether high rates of antibiotic use in the hospital setting drive community rates of MRSA. We believe that this finding should be a wakeup call to advocate for AMS in all health-care settings.
These are administrative/public health measures, they don't require new discoveries or billions in R&D to develop.
TL;DR This is a problem. It is not a new problem, it just got somewhat worse in a slightly new fashion.
In terms of personal actions - those of us in health care need to practice both hygiene (wash your hands!!!) and antibiotic stewardship. Those not in healthcare - communicate with your providers. Studies show that providers percieve that patients want antibiotics when they're sick and will get mad if we don't give them. We perceive this to a greater degree than it is actually true - so be clear with your provider that you're not looking for antibiotics if you don't need them. If you're prescribed them, ask what would happen without antibiotics.
If you stockpile - I continue to not recommend this unless you are really, really, extremely, highly knowledgeble about prescribing (or at least have a situation where you're highly knowledgeble about antibiotics in that specific situation.)
I think it's a realistic possibility that eventually there will be a completely drug resistant virus one day.
Antibiotics work on bacteria, not viruses. None of this is talking about viruses.
Drugs that work on viruses are called antivirals. There's a LOT of viruses out there we do not and never have had antivirals that work on them. (Ebola, people, remember that one?) Now, antiviral resistance is a big but different problem. No agricultural use that I'm aware of. But some viruses mutate so damn fast that resistance is quickly bred in. This is a huge issue with both influenza and HIV. [/pedant warning!]
(edit to fix minor errors/omission)
"When someone shows you who they are believe them" M. Angelou