Good News and Bad News for Antibiotics

Every credible medical and health organization, including the American Medical Association, the U.S. Centers for Disease Control and Prevention (CDC), and the World Health Organization, has said if we don't significantly reduce antibiotic use in people and agriculture, we will soon live in a world where these drugs no longer work. This frightening prospect of unwinding nearly a century of progress against bacterial infections frames three recent announcements - one good, one mostly good and one bad.

Quite simply, overuse of antibiotics is killing us. All organisms have the capacity to evolve in the face of biological threats, and germs are no exception. Faced with routine antibiotic treatments, bacteria can become resistant and these superbugs proliferate, eventually undermining the effectiveness of drugs developed to target them. According to the CDC, each year antibiotic resistant bacteria account for at least 2 million serious infections, 23,000 deaths, and $20-35 billion in healthcare costs in this country. We must cut back on these drugs, and we need to find new ones to combat resistant germs.

On the plus side, Tyson Foods, the largest meat and poultry producer in the United States, announced that within two years it would drastically reduce the use of human antibiotics in its chicken production. It's a helpful step--but we need even more. Although Tyson has joined the likes of Perdue, McDonalds and Chick-fil-A in their commitment to reduce antibiotic use, the U.S. animal agriculture industry purchased over 20 million pounds of medically important antibiotics in 2013--much of it given to compensate for overcrowding and dirty living conditions. This is more than twice as much as used in human medicine.

In largely positive news, President Obama recently announced the "National Action Plan for Combating Antibiotic-Resistant Bacteria," which will help doctors and hospitals cut back on antibiotic overuse. In human medicine, Americans use more antibiotics than most other industrialized nations, with the CDC estimating that 50 percent of such prescriptions are unnecessary. Unfortunately, the president's plan contains little to restrain usage in animal agriculture, even though research has shown that if we stop overusing antibiotics, many bacteria will lose their superbug powers and become treatable again.

For instance, in the United States penicillin and doxycycline--two older antibiotics--are considered nearly obsolete because of age. But in Sweden, with some of the best antibiotic stewardship policies in the world, these medicines remain the go-to drugs for many prevalent infections. Bacteria in Sweden aren't different than those here; they just haven't been exposed to antibiotics at the same rate. Swedish farmers use almost no antibiotics, relying on better hygiene, ventilation, and a balanced diet to keep their animals healthy. We can do the same.

Meanwhile, the bad news comes from drug giants Merck & Co. and AstraZeneca PLC, two of the few major companies still in the antibiotic discovery business. Recently they announced plans to lay off more than 200 scientists tasked with finding new ways to fight dangerous bacteria. That's discouraging, at a time when new antibiotics are sorely needed.

Unfortunately, the discovery, development and clinical testing of new drugs is expensive. In order to recoup costs, companies often focus on expensive medications that people will take throughout their lives, not short-term doses of antibiotics for temporary infections. That's one reason drug makers developed 13 classes of antibiotics between 1935 and 1968, but only three since then. Even more worrisome, only one out of five drugs that make it to the initial phase of testing in humans will be approved by the U.S. Food and Drug Administration.

Despite these challenges, we have to find ways to reinvigorate antibiotic discovery. Innovative start-up companies could tackle this work but such ventures need support. The impact investment community--which seeks return on investment in the form of profit and positive societal impact--could play a major role. Likewise, the National Institutes of Health can develop programs designed to encourage discovery. Finally, policymakers must develop legislation and regulation that spur innovation. Until then, it's vital to safeguard the drugs we have.

We are on the brink of losing antibiotics to fight even the most common infections that, if unsuccessfully treated, could kill. Doctors need to stop over-prescribing, patients must stop demanding unneeded drugs, animal agriculture needs to become transparent in cutting use, and drug companies and government must find ways to develop new antibiotics. It's a matter of life and death.

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