Antibiotic resistance is rising at an alarming rate : Goats and Soda : NPR

One of the pillars of modern medicine is showing cracks, according to a new report from the World Health Organization.

Antibiotics have turned once-deadly infections into minor inconveniences. They make life-saving interventions, from surgery to chemotherapy, safer. But every time this powerful tool is used, there is a risk – antibiotic resistance.

Among the billions of bacteria that cause infection in humans, a small proportion may be naturally resistant to a particular drug. Taking an antibiotic can clear the way for resistant bacteria to spread.

“Antimicrobial resistance is just basic evolution,” says Kevin, cityinfectious disease physician and researcher at the University of California, Los Angeles. He says we need antibiotics, but “we're in this battle and we try to lose as slowly as possible every time we treat an infection.”

People are losing this battle faster than previously thought. Around 2023 1 in 6 infections Tested in laboratories around the world, they have been found to be resistant to antibiotic treatment, according to WHO. Almost 40% of antibiotics used to treat common urinary tract, bowel, blood and sexually transmitted infections have become less effective in the past five years, the report found.

“To be honest, it’s quite alarming,” says Ramanan LakshminarayanPresident of the non-profit organization One Health Trust. “We see an increase in resistance every year, but here we see a pretty dramatic increase.”

Antimicrobial resistance is already a direct cause of approximately 1.2 million deaths according to WHO, per year and amounts to almost 5 million. Those losses could grow, says Lakshminarayan.

“We are heading towards disaster,” he says. “I shouldn’t say that—we’ve already fallen into disaster in our sleep.”

Hot spots of resistance

The jump in resistance was steepest in low- and middle-income countries with weaker health systems, the report said. Countries with less reliable tracking systems antibiotic resistance also tended to report higher levels.

“For some of the most common infections affecting tropical countries, almost 50-60% of infections are now drug resistant,” says Laxminarayan.

These higher numbers may reflect biased data, with weak surveillance systems detecting only the most severe infections, which are more likely to be resistant to antibiotics. But they can also reflect a truly higher level of resistance.

“Probably both,” says Lakshminarayan.

Weak surveillance systems tend to go hand in hand with weak health systems. That means “you probably have less capacity for infection prevention and control, less vaccination, weaker water and sanitation systems,” he says, which could cause resistance.

Easier access to essential antibiotics may also play a role.

“In many countries, you don’t necessarily need a prescription to get an antibiotic,” Ikuta says. This can lead, for example, to incorrect use treatment of viral infection with antibioticswhich may give resistant bacteria an advantage without providing any therapeutic benefit.

Less access, more resistance

While misuse is a problem in low-income countries, a bigger problem is that effective antibiotics – especially those used by richer countries when simpler antibiotics don't work – are often unavailable to those who need them most.

“In the US, if the first two drugs don't work for you, you'll probably be able to afford a third drug,” says Laxminarayan. “This option is not available to those living in Ivory Coast or Gambia.” This can lead to under-treatment of infections, which ultimately fuels the fire of resistance.

This dynamic is part of what drives increased resistance Among the most commonly prescribed antibiotics, especially carbapenems and fluoroquinolones, which target a wide range of bacteria.

As resistance to these first-choice antibiotics increases, doctors are left with older and more potentially toxic drugs or new drugs that are not widely available, especially in low-income countries, Ikuta says. “So we are either left with an incurable infection or a treatment whose side effects can be as toxic as the infection itself,” he says. “From a clinical point of view, it’s quite unpleasant.”

Getting out of this situation will not be easy.

First, it will require a clearer global picture of resistance. Although more countries are reporting data to WHO to help track global resistance levels, major gaps still exist.

Last year, 48% of countries did not provide any resistance data to WHO. Of the countries that have done so, nearly half still lack robust surveillance systems, according to the WHO.

Better surveillance data can help clinicians narrow the choice of antibiotics to use, providing more effective treatments that minimize resistance.

Doctors also need new and better antibiotics. Developing drugs that target bacteria in new ways could help people get ahead of resistance, but WHO says the global pipeline of new treatments is not developing fast enough to meet needs.

“The clock is ticking,” Ikuta says. If progress is not made and resistance continues to grow, the health care we take for granted could be in jeopardy.

“It's not just about treating acute infections and sepsis, it's about making sure surgery is safe and effective and chemotherapy is available,” he says. “These advances in medicine are driven by antibiotics, so when we lose antibiotics, we risk losing them.”