Antibiotic Resistance: The Silent Terror for Chronic Disease Patients

What is Antibiotic Resistance?

Purel, Latex Gloves, and White Lab Coats.  Everything you associate with the doctor’s office is sterilization.  Sterile is safe.  Germs = Bad.  Clean = Good.  We’ve been taught these simple mantras since kindergarten and have not looked back since. But is there more to the story then we’ve been led to believe? Is there such a reality where killing germs may actually become problematic?

As it turns out, using antibiotics in the war against germs can lead to trouble. The world has identified one of its most silent but deadly new killers.  Antibiotic resistance is quickly becoming one of our biggest adversaries in public health.  At least 23,000 deaths and over 2 million deaths are a result of diseases caused by bacteria that are resistance to antibiotics commonly administered to treat them (Center for Disease Control and Prevention, 2013).

Take a second to think back to Charles Darwin and the concept of “Survival of the Fittest;” when the doctors administer antibiotics to treat an infection, there may be trace amounts of bacteria that survive the medication for one reason or another.  Whatever trait those trace amounts of bacteria possess that allows them to survive antibiotics, will allow for them to continue to be passed onto future bacterial generations.  This then renders that antibiotic useless in fighting the emerging infection.  This is why when the doctor prescribes you antibiotics, it is of the utmost importance to take the medicine to completion.  The more bacteria you allow to survive the medication, the higher a possibility for antibiotic resistant bacteria to cause serious infection to your body.

How Can this Affect the Chronic Disease Population?

As  a chronic disease patient, a growing antibiotic resistant bacteria population is a potential seriously dangerous situation.  By the very definition of a chronic disease, we as patients spend a great deal of time in and out of healthcare settings and are at great risk of extended hospitalization.  Whether or not we are ever exposed to antibiotics, the risk exists of infection from antibiotic resistant bacteria such as the highly dangerous and publicized Methicillin-resistant Staphylococcus aureus (MRSA).  If you are exposed to a common antibiotic, you may develop resistance within your own body, but simply being in the presence of other extended hospital patients can always give way to infections.

What should each of us do to avoid infection?  In case of infection in the healthcare setting, work with your doctor to avoid overuse of the same antibiotics in your treatment.  In the home setting, limit antibiotic soap and sanitizer use for everyday hand washing. Good ole soap, hot water, and scrubbing will always remain effective in living a clean, yet safe, sanitary life style.

Antibiotic resistant infections are a danger to all patients, but especially those with chronic disease.  Diabetics with High A1c’s and lose control of their blood sugars are several times more likely than other patients to contract infections. Hyperglycemia (high blood sugars) are shown to actually decrease your body’s white blood cell immune defense!  Combining poor chronic disease management with improper antibiotic use following diabetic foot ulcers or amputations are recipe’s for even further complications.

The Epidemiologic Response

Now that we’re all sufficiently scared of antibiotic resistant bacteria, what in the world are we (we as a planet) doing to remedy the problem?

From my research as an Epidemiology student in a Masters in Public Health program, I have found there to be three especially promising proposals made to combat the problem of antibiotic resistance: (1) funding from our government (NIH), (2) a grand prize, and (3) adjusted market exclusivity to whoever creates new antibiotics.

The first proposal, NIH funding, attempts to holistically attain efforts from all of the government’s public health and safety entities. The key pillars in this proposal are to: improve antibiotic stewardship by updating education and putting a stop to unnecessary and harmful doling out of antibiotics, strengthen antibiotic resistance risk assessment and surveillance by increasing surveillance and better understanding new resistance in humans and animals, and driving new research in basic life sciences to find new treatments, drugs and other hygienic alternatives to antibiotics.  The government feels that there exists too much unnecessary antibiotic usage, which adds to the opportunity for resistant bacteria to evolve and proliferate. Researching other hygienic alternatives while also spending time to educate those in charge of antibiotic distribution could potentially alleviate the problems.

The second approach is to create a grand prize for innovative new antibiotics.  The proposal specifically suggested a two billion dollar grand prize to whoever can develop new antibiotics (ones for which there are no existing resistant bacteria strains) in hopes of incentivizing pharmaceutical companies seeking a worthwhile return on their investment.

Lastly, the third proposal brought forth the idea of new laws regarding market exclusivity.  This proposal would grant pharmaceutical firms an additional five years of marketing exclusivity in addition to what would already be granted to them by the FDA.  As it stands currently, the incentive for pharmaceutical companies to spend money on research and development is to monopolize the market for this drug for several years, netting most of their income.  Not only could this add five years to their exclusivity time for their novel antibiotic drug, but this also adds the option to transfer as much as twelve months to whatever other drug they may also produce.  In a competitive market for hit novel drugs, an extra year of exclusivity for another blockbuster drug could be extremely valuable to pharmaceuticals creating drugs outside of just antibiotics.

My Solution

The grand prize proposal may not be a sustainable model for incentivizing innovation for all future public health inquiries, but in the present case of antibiotic resistance, it should prove to be a successful method towards effective new antibiotic treatments.  I would choose a combination of this proposal with NIH funding, as my recommendation for action.  Funding to investigate both ways to eliminate unnecessary antibiotic use and other alternatives to antibiotics should still be allocated.  No matter what novel antibiotics are created, we should decrease resistance across the board for both new and old antibiotics in order to avoid reaching these same issues just a few decades into the future.  A grand prize would entail cooperation among competing pharmaceutical or life science firms alongside support and resources from the governments of developed nations.  An NIH funding increase will likely raise taxes or see cuts to other governmental departments. Although combining both scenarios will require finesse and a fine-tuning of the processes final execution, they are the steps necessary to avoid antibiotic resistant catastrophe.

• Emanuel, E. (2015, February 24). How to Develop New Antibiotics. New York Times.
• Office of the Press Secreatary. (2015, January 25). FACT SHEET: President’s 2016 Budget Proposes Historic Investment to Combat Antibiotic-Resistant Bacteria to Protect Public Health.
• Gaffney, A. (2015, April 30). Regulatory Explainer: The (Updated) 21st Century Cures Act – See more at: Http://www.raps.org/Regulatory-Focus/21st-Century-Cures-Act/#sthash.WzMyMRh7.dpuf.
• Gelijns, A. (Ed.). (1990). Modern Methods of Clinical Investigation. The National Academies PRess, 147-203.
• Sampat, B. (2010). RESEARCH LOCALLY, DIFFUSE GLOBALLY? AMERICAN UNIVERSITIES, PATENTS AND GLOBAL PUBLIC HEALTH. Journal of International Affairs, 64(1), 69-82.
• Towse, A., Kueffel, E., Kettler, H., & Ridley, D. (2010). Drugs and Vaccines for Developing Countries. In The Market for Pharmeceuticals.