Recent reports of several deaths and illnesses in Los Angeles, caused by antibiotic-resistant superbugs left behind on difficult-to-clean medical scopes, are a reminder of the crisis we face with antibiotic resistance.
As infectious disease doctors, we can tell you that these heartbreaking cases are only the tip of the iceberg. By conservative estimates, 23,000 Americans die each year from resistant infections, and more than 2 million people are sickened by them.
Seventy years ago, the man who discovered penicillin, Dr. Alexander Fleming, warned that people were improperly using it and the result would be the development of penicillin-resistant bacteria that would kill people. He was right. That experience has been repeated for decades. Our use of antibiotics when they are not needed is breeding these difficult- or impossible-to-treat superbugs.
The miracle of antibiotics is often taken for granted. Their ability to reduce death and injury from bacterial infections is far greater than virtually any other treatment in medicine. Few remember that before the discovery of antibiotics, a simple skin infection carried the same risk of death as a heart attack. Antibiotics reduced death from skin infections by a far greater amount than aspirin or clot-busting drugs reduce death from heart attacks today. But antibiotic misuse and the resulting resistance threatens this life-saving power.
California has been a leader in addressing medical misuse of antibiotics, requiring most hospitals to help protect the power of antibiotics through mandatory stewardship programs. But trying to save antibiotics by reducing the misuse of only 20 percent of antibiotics used in humans while failing to tackle the 80 percent sold for animal use makes little sense.
Much as it has on so many other issues, California can once again lead by enacting policies that safeguard the efficacy of antibiotics in the places where they’re misused most: livestock and poultry operations. There, antibiotics are used not to treat sick animals, by and large. Instead, they are fed to animals in low doses, almost daily, to speed weight gain and prevent illness common in the often overcrowded, unsanitary conditions in which these animals are raised.
Regularly feeding low doses of antibiotics to animals breeds resistant bacteria. Antibiotics kill off the susceptible bacteria in these animals, leaving room for resistant ones to thrive. The resistant bacteria can then spread to human populations by the ingestion of meat, by physical contact with animals or their byproducts, and by drinking water exposed to farm runoff or because bacteria easily transfer their genetic material to each other and resistant genes come along for the ride.
Not long ago, the bacteria that caused our patients’ infections were often responsive to many kinds of antibiotics, so we could tailor treatments to a patient’s particular medical needs. Unfortunately, rising resistance is rapidly eroding our antibiotic arsenal. As a result, doctors are often forced to choose between a diminishing pool of treatment options – between, say, a drug that might harm a patient’s kidneys and one that might not work so well.
Effective antibiotics are a shared societal trust. Each individual’s use of antibiotics affects the ability of everyone else to use them. We all bear shared responsibility for antibiotic misuse that violates that trust. Decisive action is needed.
Companies like Perdue, Tyson and Chipotle show us that a better way is achievable. They have committed to stopping the routine use of antibiotics, and these companies should be applauded for that. But the vast majority of meat and poultry producers haven’t stopped using antibiotics routinely, despite overwhelming medical and scientific evidence. The federal approach does not stop the prolonged use of antibiotics on animals that are not sick, and so we need states to act.
We need to phase out all uses of antibiotics on animals that are not sick and combine it with a robust reporting system to track progress. That would help us better respond to resistance trends. It can be done. Denmark eliminated the routine use of antibiotics and reduced resistant bacteria while hog production increased by more than 40 percent. California can lead the way in protecting us all by safeguarding the efficacy of the antibiotics we have left.
Dr. Brad Spellberg is the chief medical officer at LAC+USC Medical Center. Dr. David A. Relman is the Thomas C. and Joan M. Merigan professor in the Departments of Medicine, and of Microbiology & Immunology at Stanford University. He is chief of infectious diseases at Veterans Affairs Palo Alto Health Care System. The views are that of the authors and do not necessarily reflect the positions of the county of Los Angeles or of Stanford University or the Veterans Affairs Palo Alto Health Care System.