Hailed as a miracle drug, the discovery of penicillin marked the beginning of the antibiotic revolution. In the early twentieth century, the average life expectancy was 47 years old . Infectious diseases like smallpox, cholera, pneumonia and tuberculosis were rampant. A sore throat or skin infection could be deadly. Antibiotics, or antimicrobial drugs offered a cure, revolutionizing the treatment of infectious diseases globally. As people became less vulnerable to infection, focus shifted to today’s leading causes of death – cancer, cardiovascular disease and stroke .
However, antibiotics are becoming increasingly ineffective as antimicrobial resistance (AMR) grows due to overprescribing and other environmental factors. AMR occurs when bacteria, viruses, fungi and parasites adapt over time and become resistant to antibiotics, making infections more difficult to treat . During a recent webinar, Dr. Ari Frenkel, Co-founder & Chief Scientific Officer at Arkstone Medical Solutions, dived into AMR’s causes and emphasized the urgent need for greater antibiotic stewardship. “Working in rural America, where access to infectious disease specialists was virtually nil, I witnessed first-hand the devastation of antimicrobial resistance,” said Dr. Frenkel.
Emergence of antibiotic-resistant superbugs
As Dr. Frenkel shared in his presentation, Sir Alexander Fleming, who first discovered penicillin, warned of AMR’s dangers years ago: “The thoughtless person playing with penicillin treatment is morally responsible for the death of the man who succumbs to infection with the penicillin-resistant organism.”
Today, AMR is considered a major concern for global public health. The Centers for Disease Control and Prevention estimates that more than 2.8 million antimicrobial-resistant infections occur each year, leading to serious complications and death . “Even newly developed antibiotics cannot escape bacteria’s ability to evade or survive,” said Dr. Frenkel. Bacteria can become antibiotic-resistant through natural selection, mutations or gene transfer, a process that allows resistant microbes to pass their information to others. Some microbes known as “superbugs” have grown resistant to even the most powerful of antibiotics.
Minding the gaps in antibiotic stewardship
According to Dr. Frenkel, the overprescribing of antibiotics, particularly in cases where they are not effective, is the greatest contributor to rising AMR worldwide. For example, antibiotics are ineffective against viral infections like rhinitis, yet these infections are often treated with antibiotics. “Inappropriate prescribing may be as high as 50%. This translates to 47 million excess prescriptions each year,” said Dr. Frenkel. Facing pressure from patients and with limited infectious disease training, providers may look first to prescribing antibiotics, rather than using scientific evidence-based prescribing to effectively address the infection.
Government regulation has increased to curb the overuse of antibiotics, but greater antibiotic stewardship is needed. During his presentation, Dr. Frenkel defined antimicrobial stewardship as programs implemented to help guide physicians on the appropriate usage of antibiotics, while also monitoring AMR. Hospitals and skilled nursing facilities are now required to implement these programs. However, most antibiotics are prescribed in outpatient settings that do not have the same resources or oversight in infectious diseases.
Molecular diagnostics as a powerful defense
Although there are other contributors to AMR, such as the use of antibiotics in agriculture, antibiotic overprescription is still the primary culprit. Improving education to ensure providers know how to effectively treat infectious disease and when to use antibiotics is one step. Dr. Frenkel highlighted clinical decision support software as a tool that can help guide providers on the best path for treatment and whether treatment is needed.
In addition, molecular diagnostics like PCR testing can also be used to help diagnose infection and detect specific resistant genes that could potentially cause antibiotic resistance. “What we want to achieve is a targeted therapy,” said Dr. Frenkel, explaining that it’s important to know the cause and not just treat for possibilities. Multiplex PCR offers the ability to test for and rule out multiple pathogens at once, leading to more precise treatments.
Antimicrobial stewardship when coupled with advanced diagnostics like PCR may be our best defense against the continued rise of AMR. For Dr. Frenkel, it’s clear that AMR requires immediate action: “Antibiotics are no longer working like they used to. We must work together to provide solutions to patients around the world.”
To learn more about the growing threat of AMR and the need for antimicrobial stewardship, watch the free webinar on-demand.
For information on Thermo Fisher Scientific’s antibiotic resistance testing research solutions*, please click here.
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