An Opinion on Antibiotic Resistance

by Bernd G. Lauber, M.D.

I began my career in medicine over 20 years ago. As a young and optimistic doctor I was under the naïve impression that modern medicine was winning the battle against microbes. New antibiotics were relatively frequently introduced in the hospitals I worked at, and if a given ”bug” didn’t respond to one antibiotic, then there were plenty in the wings to switch over to. This by no means implies that the medical community was not aware or concerned about the possibility of drug resistance. We had already learned about resistant Tuberculosis and the like, and multiple antibiotic regimens were common even then. Insidiously, however, the stakes were beginning to change. New generations of microbes that were becoming harder and harder to eradicate began to manifest in clinical settings.  Terms like flesh-eating bacteria, MRSA, VRE and so on were gradually introduced into our vocabulary. Along with these terms I developed a new fear and respect for the devastating effects such infections were having on the human body. As I  pursued my career as a member of the operating room teams that had to carry out horrifically disfiguring surgeries, frequently consisting of cutting off limbs and large areas of skin and muscle tissue in attempts to halt the spread of these vicious infections. The surgical teams now frequently dressed in special protective garb, and double gloves and so on, all in attempt to try and avoid picking up these new devastating bacteria on our own bodies and carrying them home to our friends and families. It is now clear to me that even despite these precautions, many health care providers, myself probably included, are indeed already colonized with these superbugs despite our best efforts. Treatment of infections has becoming a high stakes gamble weighing the cost such treatments against the effectiveness of the drugs against these infections and their side effects. And, even if the treatment is effective, the logical question that remains to be answered in the future has to do with the next time the patient needs treatment with the same antibiotic: will the infection again respond to the same antibiotic, or has prior exposure to the antibiotic allowed a Darwinistic selection of the fittest in terms of the microbes present in the individual. Having just recently undergone 6 weeks of daily expensive intravenous antibiotics after a serious dog bite, I myself cannot help but confront such issues and decide on a course of action. New antibiotics are few at this time. In fact, in a recent review of a presentation given in the prestigious journal Chest (1), reference was made to the fact that of more than 500 new drugs currently in phase II/III clinical trials, only 5 were antibiotics, while 7 involved investigative drugs for erectile dysfunction. The public is urged to consider the implications of such a balance.

In the past many a friend and relative has called on my medical training and prescribing authority to give them a course of oral antibiotics for infections of all kinds: sinus infections, flu-like symptoms, including chest-colds, runny noses and general malaise. I have always maintained that antibiotics need to be given for specific indications, and be monitored by physicians trained specifically in their use; and not by every practitioner with prescribing authority. They are not general cure-alls for anything resembling a bacterial infection. Antibiotics are expensive, not without side effects, and fail at an alarmingly high rate. They are also completely ineffective against viruses.

Given such an outlook, where do I as a physician see my role in the future? I am powerless to halt the relentless course of microbes becoming more and more resistant to current and future therapies. Pharmaceutical companies and the medical community as a whole face a tremendous challenge to design, manufacture, test and market new antibiotic therapies. It is not surprising to me that they are spending more efforts in investigating new drugs that have good results and secure revenues (as is the case in drugs for erectile dysfunction), rather than creating new antibiotics that may become obsolete in the next several years. In addition, those individuals in our community that are the most prone to infections due to the fact that their immune system is weakened, i.e. our chronically ill and elderly patients are the least likely to have health plans that would cover the cost of new and expensive antibiotic treatments. The warnings of an impending crisis are clear and unmistakable. As a physician I believe in my duty to the public to inform myself about options available that reduce our reliance on modalities that may be predestined to fail.

We have had a tremendous success in fighting off bacterial infections since Fleming’s discovery of Penicillin in 1928, but I strongly believe we would be remiss to continue the same course of action without seriously developing strategies that may reduce our probability of needing these therapies except when absolutely necessary. In summary, I would urge the reader to gather the information in both the traditional medical community as well as alternative sources, to critically evaluate the validity of the claims made and to make necessary adjustments. It stands to reason that a strong immune system is a first and extremely important step to embarking on a new, healthier direction.