Around the Institute

Why Our Antibiotics Aren’t Working and What We Can Do to Fix It

August 13, 2015  • Zach St. Louis

Above watch the full conversation, “The Looming Antibiotic Crisis,” from Spotlight Health at the 2015 Aspen Ideas Festival. 

“About 50 percent of antibiotics that are consumed are consumed inappropriately,” said Ramanan Laxminarayan during a discussion at the Spotlight Health session of the 2015 Aspen Ideas Festival on the current problems surrounding antibiotic use. The panel, which also featured former US Food and Drug Administration Commissioner Margaret Hamburg and National Institute of Allergy and Infectious Diseases Director and Chief Dr. Anthony Fauci, discussed the dangers associated with the misuse of antibiotics and offered suggestions for what we can all do to help combat the problem going forward.

The panelists made it clear that the way in which antibiotics are currently used poses a threat to everyone. One individual who takes these drugs inappropriately contributes to the creation of more drug-resistant bacteria, they explained, which is a problem that affects not just the individual using the antibiotic, but all of society. Laxminarayan likened this issue to global climate change in that we often underestimate the impact one individual’s behavior can have in making the problem worse for everyone.

The problem of antibiotic-resistant bacteria has escalated incredibly quickly in the last few decades.

A visual shown at the beginning of the discussion illustrates that the prevalence of bacteria that are resistant to carbapenem antibiotics, a last resort medication in infections like E. coli, increased from below 10 percent to more than 50 percent between 2003 and 2012, with that number climbing each year as more individuals use these medications.

Hamburg explained that from her perspective at the FDA, a major factor that has contributed to this issue is the overuse of antibiotics in the animal agriculture industry. It is relatively inexpensive for farmers to use large amounts of preventative antibiotics to protect their animals from infection she explained; however, this practice has now become a leading factor in the creation of resistant bacteria.

The doctor’s office is another place the panelists focused on as an area where antibiotic drugs are often misused. Laxminarayan explained that the prescription for an antibiotic has become the “ticket” to ending a hospital visit for both doctors and patients, so there is a lot of incentive to write one on the first visit to the office. Historically there has been no harm in prescribing this type of drug before knowing the exact nature of the infection in the patient, and patients have come to expect an easy prescription. But now that antibiotic resistance has become such an issue, both doctors and patients need to be more hesitant about prescribing antibiotics routinely.

Creating new medications was discussed as a primary way to combat this issue, however, pharmaceutical companies are hesitant to invest in these drugs because they do not generate great financial returns, Fauci said. “Antibiotics are not a blockbuster item,” he said. “New lipid-lowering agents, new Viagras, new hypertension drugs are blockbusters because millions of people use them every day, whereas antibiotics are used in seven- or 10-day spurts.” Because of this, he continued, the best way to encourage pharmaceutical companies to get involved is by “de-risking” the process and making it a more financially viable venture, which is something his organization works to do.

The panel agreed that the biggest step that must be taken to reduce the rate at which bacteria are becoming resistant to antibiotics is to change societal behaviors.

“Twenty-five years ago, people may have been quite comfortable smoking in a room like this and now it’s no longer acceptable,” Laxminarayan said. “Hopefully we can produce that same change where people will no longer find it acceptable to go to a doctor’s office and say, ‘I need an antibiotic.’ There are other countries that have made that transition and hopefully we can as well.”