Shelburne, Shamoo and Arias: We must be smarter about antibiotics use
Thanks to antibiotic medicines, most Houstonians have never lived in a world where run-of-the-mill infections can be deadly. Our grandparents and, in many cases, great-grandparents were the last to live in such a world, but diseases resistant to antibiotics are spreading, and we all will be living in that world again soon.
Houston has the largest medical center in the world and is at the center of the antimicrobial resistance crisis. We and other leaders in the Texas Medical Center are calling for the formation of the Texas Initiative to Combat Antimicrobial Resistance, a statewide effort to galvanize research and make policy recommendations that state and local leaders can act upon to protect Texans from this growing threat.
Antibiotic medications have saved millions of lives since they became widely available in the 1940s, but on every continent, infections are on the rise from bacteria that are resistant to all or nearly all available antibiotics. This is not a problem of the developing world. Antibiotic resistance has a direct impact on health care delivery in the United States, particularly in Texas. Indeed, the U.S. Centers for Disease Control and Prevention conservatively estimates that at least 23,000 people in the U.S. die each year from these infections, and the United Nations estimates the worldwide death toll could reach 300 million by 2050, with a staggering economic toll of $100 trillion.
The first step in addressing the threat is understanding how it arose. For starters, consider that most antibiotic medications are derived from antimicrobial chemicals that are themselves produced by microbes. Single-celled organisms have competed with one another for more than 4 billion years, and just as some have evolved ways to produce chemicals that kill their competitors, others have evolved defenses against those chemicals. The overuse of antibiotic drugs by humans has accelerated how quickly disease-causing organisms have developed such defenses.
In the United States alone, more than 260 million courses of antibiotics are prescribed in outpatient clinics each year, with hundreds of millions more courses given in hospitals. But far more are used in agriculture. Indeed, more than 80 percent of all antibiotics used in the U.S. are given to farm animals, not to fight infection but simply to promote growth.
The problem is compounded by the economics of drug production. As more bacteria become resistant to antibiotics, they become less profitable for drug companies to produce. As a result, major pharmaceutical companies today have stopped investing resources to develop new antibiotics.
Developing new antibiotics should be a national and international priority, but it can take years to create new drugs. In the meantime, we must be smarter about using the antibiotics we have, and local leaders and state officials each have a role to play, as do doctors and citizens.
Building from the experience of Harris County Public Health in tackling infectious diseases such as HIV and tuberculosis, we should devote a similar approach to mitigating antimicrobial resistance in our community. We have only hospital-based, fragmentary knowledge about the problem of antimicrobial resistance in Houston. An active surveillance program should be implemented.
The Cancer Prevention and Research Institute of Texas, which has resulted in dramatic improvements in how cancer is prevented and treated in Texas and beyond, demonstrates how state support for specific health programs can be transformative. Texas can make a similar impact regarding antibiotic resistance.
Finally, the impact of antimicrobial use in farm animals cannot be overlooked. The widespread use of antibiotics in animals destined for human consumption means that we are exposed to antibiotic resistant bacteria in our daily meals. The Department of Agriculture has released a federal plan to combat antimicrobial resistant bacteria, and the state of Texas needs to step up and become a leader in this effort as well.
The entire community should also be aware of the problem and take antibiotics only as prescribed and for the indicated duration of time.
The “post-antibiotic” era is upon us, and Houstonians and Texans should help lead the global fight to halt the spread and minimize the loss of life from antibiotic-resistant disease. We should act now and help the Texas government make a difference in combating this problem.
Shelburne is an associate professor in the department of genomic medicine at MD Anderson Cancer Center. Shamoo is vice provost for research at Rice University. Arias is a professor in the department of internal medicine-infectious diseases at UTHealth.