Antibiotic resistance is rising at an alarming rate : Goats and Soda : NPR
This micrographic image depicts a gastrointestinal bacteria that can become pathogenic after trauma, surgery, or other disturbances.
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One of the pillars of modern medicine is showing its cracks, according to a new report from the World Health Organization.
Antibiotics have turned once-deadly infections into minor inconveniences. They make life-saving procedures, from surgery to chemotherapy, safer. But every time this powerful tool is used, there is a risk: antibiotic resistance.
Of the billions of bacteria causing infection in an individual, a small fraction may be naturally resistant to a given drug. Taking an antibiotic can pave the way for these resistant bacteria to spread.
“Antimicrobial resistance is just a fundamental development,” says Kevin Ikutainfectious disease physician and researcher at UCLA. He says we need antibiotics, but “we’re in this battle that we’re trying to lose as slowly as possible every time we treat an infection.”
The humans are losing this battle faster than previously thought. In 2023, approximately 1 in 6 infections tested by laboratories around the world were resistant to antibiotic treatment, according to the WHO. The report indicates that nearly 40% of antibiotics used to treat common urinary, intestinal, blood and sexually transmitted infections have lost their effectiveness over the past five years.
“Frankly, it’s quite worrying,” says Ramanan Laxminarayanpresident of One Health Trust, a non-profit organization. “We see an increase in resistance every year, but here we see a pretty sharp increase.”
Antimicrobial resistance is already directly responsible for approximately 1.2 million dead per year and contributes almost 5 million, according to the WHO. This toll could rise, says Laxminarayan.
“We are descending into a catastrophe,” he said. “I shouldn’t say that’s the case – we’ve already sleepwalked into disaster.”
Resistance hotspots
The rise in resistance was greatest in low- and middle-income countries with weaker health systems, the report found. Countries with less robust monitoring systems antibiotic resistance also tended to report higher levels.
“For some of the most common infections affecting tropical countries, almost 50 to 60 percent of infections are now drug resistant,” says Laxminarayan.
These higher figures could reflect biased data, in which weak surveillance systems only detect the worst infections, which are more likely to be resistant to antibiotics. But they could also reflect genuinely higher levels of resistance.
“It’s probably both,” says Laxminarayan.
Weak surveillance systems tend to be accompanied by weaker health systems. This means “there is probably less infection prevention and control, less vaccination, a weaker water and sanitation system,” he says, which can lead to resistance.
Easier access to basic antibiotics could also play a role.
“In many countries, you don’t necessarily need a prescription to get an antibiotic,” says Ikuta. This can lead to misuse, e.g. treat a viral infection with antibioticswhich could give a boost to resistant bacteria without providing any therapeutic benefit.
Less access, more resistance
While their overuse is a problem in low-income countries, the bigger problem is that effective antibiotics – especially those that richer countries use when the most basic antibiotics fail – are often out of reach of those who need them most.
“In the United States, if the first two drugs don’t work for you, you could probably afford to buy the third,” says Laxminarayan. “This option is not available to anyone living in Ivory Coast or Gambia.” This can leave infections insufficiently treated, ultimately fueling the fire of resistance.
These dynamics are part of what motivates increased resistance among the most commonly prescribed antibiotics – particularly carbapenems and fluoroquinolones – which target a wide range of bacteria.
As resistance to these first-line antibiotics increases, doctors are left with older, potentially more toxic drugs, or newer drugs that aren’t widely available, especially in low-income countries, Ikuta says. “So we end up with either an incurable infection or a treatment whose side effects can be as toxic as the infection itself,” he says. “It’s quite complicated, clinically.”
Getting out of this mess won’t be easy.
On the one hand, this will require a clearer overall picture of resistance. Even as more countries submit data to the WHO to help track global resistance levels, there are still significant gaps.
Last year, 48% of countries reported no resistance data to WHO. Of the countries that have done so, almost half still lack robust surveillance systems, according to the WHO.
Better monitoring data can help doctors determine which antibiotics to use, ensuring more effective treatments that minimize resistance.
Doctors also need newer, better antibiotics. Developing drugs that target bacteria in innovative ways can help humans get ahead of resistance, but WHO says the global pipeline of new treatments is not arriving fast enough to meet the need.
Time is running out, Ikuta says. If progress is not made and resistance continues to grow, the medical care we take for granted could be at risk.
“It’s not just about treating acute infections and sepsis, it’s also about ensuring that surgery is safe and effective and that chemotherapy is available,” he says. “These advances in medicine rely on antibiotics, so when we lose antibiotics, we risk losing them.”
