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The rise of superbugs and what we can do about them

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From a December 31st article in the Chicago Tribune

“For an American in the 21st century, it is hard to imagine the world before antibiotics. At the beginning of the 20th century as many as 9 women out of every 1,000 who gave birth died, 40 percent from sepsis. In some cities as many as 30 percent of children died before their first birthday. One of every 9 people who developed a serious skin infection died, even from something as simple as a scrape or an insect bite. Pneumonia killed 30 percent of those who contracted it; meningitis killed 70 percent. Ear infections caused deafness; sore throats were not infrequently followed by rheumatic fever and heart failure. Surgical procedures were associated with high morbidity and mortality due to infection.”

— Report to the President on Combating Antibiotic Resistance, Sept. 2014

Many Americans might heave a sigh of relief that they live in an era of powerful antibiotics that wipe out common bacteria and other virulent bugs.

But just as antibiotics grow stronger, bacteria evolve to evade them. So-called superbugs become resistant to those drugs, forcing researchers to develop newer, more powerful antidotes. The bacteria are winning, researchers say. They’re evolving faster than scientists can develop new drugs to kill them.

The rise of antibiotic resistance in the U.S. and across the world isn’t a limited outbreak that can be cured with even more powerful drugs. It isn’t off in the future. It is here. Now. And it is dangerous.

In India, tens of thousands of newborns are born with bacterial infections that are resistant to most known antibiotics, The New York Times reports. Result: More than 58,000 babies died in 2013, according to a study. That’s only a fraction of an appalling 800,000 newborns who die annually in that country. But the number of antibiotic resistant deaths is rising. Just as alarming: Researchers say a significant share of the bacteria in India are now immune to virtually all antibiotics. “Five years ago, we almost never saw these kinds of infections,” a New Delhi doctor told the newspaper. “Now, close to 100 percent of the babies referred to us have multidrug-resistant infections. It’s scary.”

India is an extreme case because of its abysmal sanitation, but no country is immune from this growing threat.

In the United States, some 23,000 people die and 2 million fall ill every year from resistant bacterial infections because routine antibiotics fail, the federal Centers for Disease Control and Prevention reports. The CDC ranked antibiotic resistance as the second most challenging public health threat of 2014, just behind Ebola.

For years, U.S. public health officials have warned that the widespread and indiscriminate use of antibiotics would lead bacteria to evolve defenses. It is more than that: U.S. officials now call the rise of antibiotic-resistant bugs a threat to national security. They’re right. Think about the recent fear and panic over the Ebola virus, another scourge that has no cure and is resistant to known treatments. Now think about a much wider panoply of bacteria re-emerging to threaten broad swaths of the American population.

There are now more than 17 types of antibiotic-resistant microbes, researchers say, and the list is growing. A British government task force recently predicted that, left unchecked, superbugs by 2050 will kill more people worldwide than cancer will. “If we fail to act,” says British Prime Minister David Cameron, “we are looking at an almost unthinkable scenario where antibiotics no longer work and we are cast back into the dark ages of medicine.”

But the battle is not lost. In September, President Barack Obama directed federal agencies to attack this national security threat by tracking — and discouraging — antibiotic overuse in hospitals. A presidential panel also recommended increased federal incentives for drug companies to develop new, next-generation antibiotics. That’s a good start.

Patients, too, have a role. Half of antibiotics prescribed are unnecessary or inappropriate, the CDC says. Many people who go to their doctors demand antibiotics, even if they’re not called for. Many doctors prescribe a drug, sometimes just to appease patients, knowing there is little chance that it will make a difference.

Doctors should avoid prescribing antibiotics over the phone, and bone up on common infections “because so many of them don’t require antibiotics,” Dr. Sarah Sutton, a Northwestern University infectious disease specialist, tells us. “Patients need to say, ‘I don’t want antibiotics unless I absolutely need them’ — and doctors need to tell patients when they don’t need them.”

In other words: No more caving.

Because miracles can boomerang

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