It’s 2050: Antimicrobial resistance (AMR) is the global leading cause of death. The total GDP loss is over $100.2 trillion, and AMR has claimed the lives of over 10 million people.
Every year in the United States, antibiotic resistant infections cause over 2 million illnesses and over 23,000 deaths. The Review on Antimicrobial Resistance published the aforementioned shocking human and economic cost estimates in order to highlight the danger of allowing AMR to persist at its current level.
AMR is an urgent global public health emergency, and anecdotes about the devastation of its rise have become commonplace. Antibiotic susceptibility testing of the bacteria that claimed the life of a 70-year-old female resident of Reno, Nevada in 2016 revealed that this strain was resistant to 26 antibiotics. The gravity of this global health emergency has raised paramount concerns: Are we at the dawn of an antibiotic apocalypse? Is there anything that we can do?
Although the emergence of AMR is a natural phenomenon caused by chance mutations in bacteria, it has been accelerated by our irresponsible use of antimicrobials. Antimicrobials, such as antibiotics, create an intense selective pressure on the bacterial population, which drives natural selection and enables resistant populations, “superbugs,” to survive and thrive.
Ubiquitous mismanagement is the cause of our current battle against AMR, and an exploration of common antimicrobial malpractice provides insight into the extent of this misuse. Questionable antibiotic prescription practices by physicians at the front lines of our fight against AMR have contributed to this growing public problem. As a result, The National Action Plan for Combating Antibiotic-Resistant Bacteria established a goal to reduce inappropriate antibiotic use by 50% by 2020. A recent study exploring the extent of inappropriate outpatient antibiotic use found that approximately 1 in 3 of these prescriptions were unnecessary, and the CDC estimates that this equates to approximately 47 million excess prescriptions.
Interestingly, research suggests that patients play a role in exacerbating the over-prescription of antibiotics. A recent study in the UK revealed that 55% of physicians felt pressure to prescribe antibiotics to patients, despite thinking that they were unnecessary, and 45% of physicians had prescribed antibiotics for a viral infection, despite being aware that they would be ineffective. These results suggest that there can, and must, be standardized action taken to improve prescription practices.
It is important to recognize that antibiotic prescription practices are not an immutable social norm. A 2017 study suggests that doctors can be “nudged” to reduce poor antibiotic prescription practices. When physicians were required to add a written justification for prescribing antibiotics to the patient’s electronic medical record, and physicians received monthly emails directly comparing their rate of inappropriate prescriptions to that of their peers, inappropriate prescriptions decreased by 16-18%. Thus, not only must we provide incentives to ensure that antibiotics are prescribed properly, it is also evident that education and advocacy campaigns are of the utmost importance. We must also ensure that we are doing our part as patients to be educated about when and how we should properly use antibiotics.
Of course, it is impossible to discuss the rise of AMR without evaluating the major contributions of the agricultural industry. A staggering report revealed that the livestock industry accounts for 80% of the total antibiotic use in the United States on an annual basis. Indiscriminant use of antimicrobials by the livestock industry to promote growth and prevent infection has undoubtedly contributed to the rise of AMR. A lack of consistent data has resulted in a great deal of backlash from the livestock industry about placing limitations on antibiotic use. The potential economic costs of scaling back antibiotic use in livestock pales in comparison to the costs to humanity if AMR continues to rise at its current rate.
The discovery of antibiotics has revolutionized modern medicine, and their loss would be devastating. The misuse and overuse of antibiotics puts all of us at risk and will undermine the safety of some of our most significant advancements in medical technology. Living in a world where a scraped knee could spell a death sentence, and where routine procedures will come with incalculable risks is an incomprehensible reality, but it is the direction we are heading in if we do not alter our current trajectory. As we approach the cusp of disaster, we must remember that hope is not lost. The world must take immediate, comprehensive action to combat antibiotic resistance.
