Are we on the precipice falling into a world without effective antibiotics?
"[T]he confluence of inexpensive medicines, sometimes of dubious quality, widespread use of antibiotics, instead of the more traditional and effective methods of hygiene, in addition to the physician incentives to overprescribe and the vast dense urban settings, have created a perfect storm for the emergence of drug-resistant bacteria," Roger Bate, an economist and international health policy researcher, wrote in a column for the American Enterprise Institute.
Here are six takeaways on the factors laying the groundwork for an antimicrobial "perfect storm" from Mr. Bate's article, based on his recently published research in Economic Perspectives, a policy paper series by the American Enterprise Institute.
- The risk of rampant antibiotic resistance is accelerating in part because inferior ingredients and inadequate production techniques are being used to create the stores of antibiotics used today. The companies producing these medicines have few financial incentives to investigate novel antimicrobial agents and as more and more antibiotics become ineffective, the options for alternatives are becoming slimmer and slimmer.
- Poor quality medications are in large part to blame for the growing problem. India is one of the "ground zeros" for issues arising from substandard medications. Research suggests treatment with antibiotic medications that use sub-therapeutic concentrations of active ingredients trigger the proliferation of resistant bacterial strains.
- Due to the nature of the drug production industry, manufacturers seek the lowest-cost productions methods. In the West, physician feedback and regulations tend to quash long-term survival of poor-quality products, but in emerging nations, there is much less scrutiny for drug companies. In some nations, this type of "corner-cutting" is actually defended by federal regulation.
- In some of these nations, namely India, where much of Mr. Bate's research is centered, widely available medications offer sub-therapeutic levels of antibiotics and they become a substitute for proper sanitation and are available over the counter. This is the foundation of a breeding ground where superbugs can adapt and become resistant. India not the only nation with this problem, but multiple strains of resistant bugs are thought to have originated there.
- The lack of standards in antibiotic production from country to country has been identified for many of the most important antibiotics. While some regulations exist in the West to weed out and control for the importation and use of substandard medicines, that does little to stop the spread of bacterial strains that grow resistant elsewhere and then traverse the globe.
- The author concludes the international medicine community and global regulatory bodies must agree on more effective methods to identify substandard antibiotics and remove them from the supply chain. Otherwise there is a risk of returning to the pre-antibiotic era where infections that are now routinely treatable will transform into life-threatening situations.