When the antibiotics stop working

We’ve all grown accustomed to assuming our dominance over the microbiome. All it took was a few little pills to annihilate them. …or so we thought.

That really pissed them off.

They were here long before we were, and don’t need sex to multiply (and evolve) at half a million times the rate of human reproduction. They may not have brains, but they outnumber us by a quintillion to one (1). Each human body contains 10 times more microbial cells than human cells. And we are just now scratching the surface of the role of microbiota in human and environmental health – but we know they largely determine whether or not we develop a number of health conditions like diabetes, obesity, autoimmune conditions (like Crohn’s disease, Multiple Sclerosis, and Rheumatoid Arthritis), depression and even Autism (2).

We hadn’t even imagined this until the 1990s, after decades of liberal antibiotic use – which represents only a few human generations, but millions of microbial generations.

But, as early as 1945, Alexander Fleming, who had been credited with the discovery of the antimicrobial properties of Penicillium notatum, warned of antimicrobial resistance to the miracle compound he had isolated (3).

Unfortunately, he made the mistake of telling this to other humans, who (in this culture at least) are not fond of thinking much past the events of the day or maybe the week, what to speak of considering the impact of their decisions on the next seven generations…so, what follows should be no surprise.

His warnings were not heeded. Doctors and midlevel providers were increasingly threatened by the specter of malpractice suits filed by unhappy patients with viral upper respiratory infections who did not receive the antibiotics they came to the office for.  So they kept prescribing them – for conditions that would have easily been fought off by the patient’s immune system – and made them more resilient in the process.

The CDC in 2013 warned us all about some pretty scary multi-drug-resistant organisms – the top 3 being the infamous Clostridium difficile (C. diff), carbapenem-resistant Enterobacteriaceae species, and (gulp!) cephalosporin-resistant Neisseria gonorrhoeae (yes, Gonorrhea). (4). Apparently, less of a threat are vancomycin-resistant Enterococcus species, methicillin-resistant Staphylococcus aureus (MRSA), and fluoroquinolone-resistant Mycobacterium tuberculosis. Those all seem pretty bad to me. And at work as a nurse practitioner, I often see a fair number of other bugs that are resistant to all but the most toxic drugs available, and occasionally even to those.

I won’t bore you with any more italicized bug names – but will highly recommend the documentary Resistance for anyone interested in a crash course in antibiotic resistance.

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