A couple of weeks ago, a Nature article argued that the antibiotic resistance crisis is on a par with global warming. I think the resistance crisis is worse than the global warming crisis.
Here’s why: if I were appointed El Supremo–which would be a really bad idea by the way–I could get us to 95 percent renewable energy. It wouldn’t be easy, and would require some (or lotsa) fundamental changes, but there is a path to follow. Of course, in the real world, we won’t do this because we’re fucking idiots. Hell, Republicans lose their shit over energy-efficient light bulbs, so good luck saving the planet.
Lo, there are assholes, and they walk among us.
But with antibiotic resistance, the problem is much more difficult. First, some potentially good news. On the diagnostics front, we have made very good progress over the last decade, and I think we’ll only get better. To the extent that we can diagnose infections accurately (as opposed to what we do now in the initial stages, which is make an educated guess), we can use older antibiotics instead of newer drugs when appropriate, and not use antibacterials to treat viral infections.
We are also slowly realizing–or relearning–just how critical infection control and surveillance are (‘Partying like it’s 1899’). With the advent of genomic-based surveillance and the continuing integration of informatics into biology (as ugly and kludgey as that can be), we will only get better at identifying outbreaks and sources of antibiotic resistant organisms and resistance genes. We can prevent or contain the spread of resistance–if we’re smart (though see the “Lo, there are…” bit above).
But these strategies, as important as they are in preserving the power of the antibiotics we currently have, do nothing to expand the arsenal. And here’s where we’re screwed. I don’t think anyone has any idea where the next class of drugs will come from. Yes, there are attempts to enhance the effectiveness of existing antibiotics, such as compounds that dislodge urinary tract infection bacteria from the walls of urinary tract, making them more susceptible to lower concentrations of antibiotics. But very little that I’ve heard of over the last decade has actually panned out. One reason drug companies are pulling out of antibiotics is because they can’t figure out how to do it; for the most part, the large companies still investing in antibiotic research are doing so out of noblesse oblige as much as anything else.
Hopefully, I’m wrong: maybe there’s some company somewhere that’s figured this out, but there doesn’t seem to many or any promising leads on the drug development front. Politics, especially around surveillance and drug use, will be a problem. But nobody seems to have any concrete plans to develop new classes of antibiotics. That’s not politics, but a much more serious problem.
We really don’t want to live in a world where even one to two percent of clinical infections are untreatable or where E. coli and Klebsiella urinary tract infections are the next major sexually transmitted diseases.
If you think global warming is bad, wait until we can’t treat some infections at all. That will be disruptive–in the non-Silicon Valley sense of the word–to say the least.