Are We Running out of Antibiotics?

Article excerpt

Byline: Jeneen Interlandi

As more bacteria become resistant to the most powerful drugs in our arsenal, new weapons are getting harder and harder to find. Why we need to change the way we think about treating infection.

Hardly any doctors still practicing can remember life before antibiotics, when people were routinely hospitalized for common infections, and the threat of deadly Staphylococcus shadowed even the simplest surgery. But infectious-disease specialists like Brad Spellberg of UCLA's David Geffen School of Medicine have been reading up on those days because of a growing fear they are not all in the past. Wealthy countries take for granted the triumph of science over bacteria, but increasingly doctors are coming up against infections that can be quelled only by the most powerful antibiotics known to medicine--or by none of them. "It's already happening," says Spellberg, to the tune of roughly 100,000 deaths a year from antibiotic-resistant infections in the United States alone. "But it's going to become much more common." Imagine a world in which antibiotics resemble chemotherapy drugs--producing toxic side effects and unpredictable outcomes instead of the guaranteed cures we have come to expect--and you can understand what keeps Spellberg awake at night.

In the future, historians of science may debate whether victory over bacteria was ever within our grasp. But it seems almost certain that the 60 or so years after penicillin came to market will eventually be viewed as just an interlude in the eternal war between us and them. We are multicelled animals of astonishing complexity and delicacy, moving through a world in which they vastly outnumber us. They are single-celled organisms so primitive they lack even a nucleus, marvelously adapted to multiply inside us--under the right circumstances, to consume our flesh and poison us with their waste. For a few decades we gained the upper hand through the use of antibiotics, natural substances that are as toxic to germs as germs are to us. But our ingenuity is in a desperate race against their ability to reproduce. More and more strains of bacteria are developing biological countermeasures to antibiotics--cell membranes that won't let them in, tiny pumps that push them back out, biochemical tweaks that make them harmless. Evolution is a process that has been at work on earth for hundreds of millions of years; modern biological science has been around for less than a century and a half. Which would you bet on?

We have handicapped ourselves in this race, partly through carelessness and partly as an outcome of the complex politics and economics of drug policy. We've squandered our antibiotics through overuse--in animal feed, or on diseases they can't cure, such as influenza--and, paradoxically, by under-use. Particularly among the poor and illiterate, it's not uncommon for patients to stop taking antibiotics as soon as they feel better--leaving behind a residual population of resistant bacteria to multiply and spread.

For a while this didn't matter, because there were always new antibiotics being discovered. Beginning in the 1940s, when penicillin first hit pharmacy shelves, humanity embarked on a decades-long quest to collect as many soil samples as possible and probe them for potential miracle cures. Allied soldiers scooped up dirt from the African front, the National Geographic Society collected samples from the top of the Himalayas, and schoolchildren everywhere dug up shovelfuls from parks and fields. Pharmaceutical companies led the charge in harvesting this vast collection, ultimately producing some 200 new drugs in a mere three decades.

But by the mid-1980s, the discoveries had slowed to a trickle. "It's a bit like oil," says Spellberg, author of the book Rising Plague. "There's still a lot out there, but we've harvested all the easy gets. There are very few places left where you can just tap the ground and find some bountiful reserve. …