Wednesday, June 15, 2011

The end of antibiotics:

We have discussed (here and here2) the issue of declining usefulness of our most common antibiotics in the past.  We are not the originators of this tale, nor the final word, so I wanted to have an update. 

Remapping Debate has had a couple posts on this of which I am only highlighting here.

Eric Kroh, Remapping Debate, 13 June 2011, Hat tip Megan McArdle

Oral antibiotics have long been the standard treatment for urinary tract infections, which are diagnosed in one out of three women before the age of 24. But doctors are now seeing E. coli infections of the urinary tract that are resistant to all oral antibiotics, requiring patients to go to the hospital for intravenous antibiotic treatment, Spellberg said. If the antibiotics resistance rate in E. coli becomes high enough, then all patients with urinary tract infections would have to be hospitalized, he said.

And going to the hospital has itself become alarmingly risky. Already, 1.7 million people in the U.S. acquire infections in the hospital each year, resulting in 99,000 deaths, according to the Centers for Disease Control and Prevention.

In the pre-antibiotic era, people who got a simple skin infection had a 10 percent chance of dying, and people who contracted pneumonia had a 60 percent chance of dying, Spellberg said.

While he didn’t think mortality rates from infectious diseases would become as high as they were in the days before antibiotics, Spellberg said it was reasonable to think that if we continue down the road we are on today, there will be an increasing number of pathogens for which we have no defense at all.

“We will slowly go back to the situation of the early 20th century when infectious disease was such a scourge that people didn’t live long enough for heart disease and cancer to be our biggest problems,” said Margaret Mellon of the Union of Concerned Scientists.

Increasing incidence of antibiotic-resistant infections
Source: Centers for Disease Control and Prevention. Reprinted with permission of the Infectious Diseases Society of America

Remapping Debate also had a very good piece on the over usage of antibiotics in the food industry. Not to help with animal health, but to help fatten them up.

The recently married Megan McArdle at the Atlantic got this ball rolling with her own observations on the article above, and on a book that she had read on the subject.

Megan McArdle, The Atlantic, 14 June 2011. Hat Tip MR.

I didn't start to understand the radical implications that antibiotic resistance has for health care practice until I read the absolutely gripping Rising Plague, by an infectious disease specialist who points out just how much of modern medicine is dependent on being able to control bacterial infection.

· Without antibiotics, there would be very little elective surgery. Before sulfa drugs, surgery was a very serious business with a high risk that a patient might die of some complicating infection
· Without antibiotics, forget organ transplants. The immune suppression would almost certainly be fatal in a pretty short time period. HIV would also be more dangerous.
· Without antibiotics, retirements would get shorter again. Before antibiotics, the average 60 year old who caught pneumonia was more likely than not to die of it than not. That's why they used to call pneumonia the "old man's friend". Nor is pneumonia the only potential killer.
· Without antibiotics, maternal mortality would be a lot higher. So would mortality from abortions, dramatically. While backalley abortions were horrible, and did kill people up until legalization, the theatrical figures thrown around by the pro-choice movement were mostly due to the lack of antibiotics, not the butchery of the freelance abortionists. Between 1936 and 1960, the number of deaths from abortions seems to have fallen by something between 80-95%. Looking strictly at mortality, you'd probably be much better off getting an illegal abortion with antibiotics than a legal one without.
· Neonates would also be much more likely to succumb to infection, since their immune systems are underdeveloped.
· Chronic infections can lead to various sorts of cancer (H. Pylori, the bacteria that causes ulcers, also causes stomach cancer). These would take more people before they got Alzheimer's.
· The severely disabled would have much shorter life spans. Without antibiotics, there would be no way to treat the bed sores, or the lung and urinary tract infections that are common for people with limited sensation or mobility.
· Strep and its evil cousins, scarlet and rheumatic fevers, would once again be a major killer and disabler of children.
That you can have such an absolutely major problem facing us, and we cannot even get started by limiting the use of antibiotics in animals, little less using them on a more restrictive basis with humans, is indicative of just how locked into a stasis our society is.

But I digress, our chain has not run out. A commenter at Ms. McArdle's posting made some very good points.

But I digress, our chain has not run out. A commenter at Ms. McArdle's posting made some very good points; of which we had discussed briefly in the past here3.
Commenter jmgalanter notes
Oh, it gets even more depressing. You haven't even mentioned tuberculosis; the susceptible bacteria is hard enough to treat (6 months of three or four antibiotics). Now imagine multidrug resistant (MDR) or extensively drug resistant (XDR) bacteria. There are now even strains that are resistant against every anti-tuberculous antibiotic out there.
From the Wikipedia entry on TB:
One-third of the world's current population has been infected with Mycobacterium tuberculosis, and new infections occur at a rate of one per second. About 5-10% of these latent infections will eventually progress to active disease, which, if left untreated, kills more than half of its victims. Annually, 8 million people become ill with tuberculosis, and 2 million people die from the disease worldwide. In the 19th century, tuberculosis killed an estimated one-quarter of the adult population of Europe; and by 1918 one in six deaths in France were still caused by TB. By the late 19th century, 70 to 90% of the urban populations of Europe and North America were infected with M. tuberculosis, and about 40% of working-class deaths in cities were from TB. During the 20th century, tuberculosis killed approximately 100 million people. TB is still one of the most important health problems in the developing world.

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