The Risks of Antibiotic Overuse: A Neglected Public Priority

Since their introduction in the 1940s, antibiotics have been the foremost treatment for previously incurable bacterial illnesses. During the early 20^th century, diseases such as typhoid fever, scarlet fever, and tuberculosis were commonplace. In the pre-antibiotic world, even a minor wound had the potential to be deadly. But with the mass introduction of antibiotics, these diseases dramatically declined and complex medical procedures, such as organ transplants, plastic surgery, and cesarean sections, became routine.

Though antibiotics offered life-saving benefits, they were not without consequence. During his Nobel Prize speech on the discovery of penicillin, Alexander Fleming warned his audience about the repercussions of antibiotic overuse. He stated, “It is not difficult to make microbes resistant to penicillin in the laboratory by exposing them to concentrations not sufficient to kill them, and the same thing has occasionally happened in the body.” In other words, microbes that are susceptible to low concentrations of antibiotics are killed, resulting in a selective pressure for the survival of the microbes that are even remotely resistant. Subsequently, the resistant microbes have the ability to multiply in a non-competitive environment and share resistance genes with other microbes in the community.

Even though scientists are revealing detrimental effects antibiotics are having on human health, Fleming’s warning has largely been ignored by the general public. Patient refusal of antibiotic treatment has been rare. In many instances, patients who seek medical care often expect to receive antibiotics upon medical evaluation, sometimes even as a preventative measure. In fact, approximately 50% of antibiotics are improperly prescribed.

This image is created using discs of a common antibiotic, ciprofloxacin. The antibiotic dissolves out into the nutrient jelly. Some blue-colored bacteria are unable to grow near the ciprofloxacin; they are sensitive. The lilac-colored bacteria can survive closer; they are more resistant to the antibiotic. This creates the halo effect around the antibiotic discs.

Though the rise of antibiotic resistant microbes has caused an estimated two million illnesses and 23,000 deaths each year in the United States, there is limited support for antibiotic research. This deficiency has been fueled by a combination of low government funding, the long-term commitment required to discover new antibiotics, and a lack of awareness from the general public. This increased dependence and lack of advancement for antibiotic research has triggered fear by scientists of an impending “antibiotic winter,” where our lowered ability to fight infection could put us at high risk of future outbreaks. In an attempt to curtail this lack of support, the Obama-Biden administration began developing an antibiotic action plan in March 2015. This report calls for continued modification of existing antibiotic compounds and discovery of new antibiotic classes. It is hoped that by following the established strategies, the incidence of urgent and serious threats that antibiotic resistance poses will be reduced, thereby preserving the drugs’ effectiveness.

Antibiotic resistant infections are not the only side effect of these drugs. In the past decade, scientists have begun to suggest that our modern reliance on antibiotics may be having a negative impact on our health. Recent studies have shown that by five years of age, children develop an individually distinct gastrointestinal microbiome that fully resembles an adult in terms of composition and diversity. The microbiome has been attributed to many aspects of human health, and as such, its development is critical. It is reported that the average child in the United States receives an estimated three courses of antibiotics by the time they are two years old. This early exposure is thought to threaten the healthy development of the microbiome and cause “modern plagues” such as diabetes, obesity, arthritis, and depression.

Interestingly, the overuse of antibiotics has not been a major public discussion point compared to the debates on vaccination. Vaccines have been placed in the limelight after a scientific journal article, published by Dr. Andrew Wakefield, reported that vaccines are responsible for autism. The anti-vaccination movement was intensified and has impacted the current presidential elections. While scientists have comprehensively disproved the claims that Dr. Wakefield published, the continuing debates on vaccines are concerning. From a public health perspective, the anti-immunization movement not only creates a possibility of wide-scale infectious outbreaks, but it also stands as a distraction from urgent public health concerns like the overuse of antibiotics.

There is a lot in the news about drug-resistant bacteria. Here you can see discs containing nine commonly-used antibiotics in hospitals. The dark-blue colored bacteria can grow quite happily in the presence of eight of them; the antibiotics do not kill it. These bacteria are resistant to all but one of the antibiotics we have available.

Confusion among the general public about antibiotic resistance may be fueling a lack of concern. A recent study done by the Wellcome Trust foundation identified that many people are alarmingly uninformed about the concerns that antibiotics pose. One of the most stunning findings revealed that the public believes antibiotic resistance is something a person develops, not bacteria. Further results showed that many consider antibiotic resistance a sensationalized problem, making it irrelevant to them. The misconceptions about antibiotic resistance were so striking that the Wellcome Trust foundation has stopped using the phrase “antibiotic resistance” altogether, and now use “drug-resistant infection.” They hope that a simple, clear language that focuses on illness and implications will help the general public understand the true meaning of antibiotic resistance.

With antibiotic overuse being largely unrecognized by the general public, scientists must continue to facilitate public engagement and understanding. The introduction of accessible language to describe antibiotic resistance was the first step to addressing the divide that exists. Collaborative exhibits such as “Gut Flora,” “The Secret World Inside You,” “Micropia,” and “Invisible You” challenge the public to explore how microbes are associated with human health and also illustrate the consequences of antibiotic overuse. Existing hurdles such as enacting open access to peer-reviewed publications may allow for broader audiences to engage with current scientific findings. Health-care professionals should provide supplemental patient education and practice antibiotic stewardship. All of these collaborative efforts between the government, scientific community, and health-care professionals will continue conversations and enhance public awareness of the urgent threat that antibiotic resistance poses.

Featured Images: “Gut Flora” is an exhibition that features gut bacteria stamped in botanical designs on color-changing nutrient jelly plates. The plates contain paper discs infused with antibiotics, which dissolve into the jelly. The images explore how bacteria found in the gut interact with antibiotics, and what this means for our health. They are a collaboration between University of Oxford Scientist Dr. Nicola Fawcett, and photographer Chris Wood, Modernising Medical Microbiology (Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0)). Dr. Fawcett is a hospital doctor, and studies how antibiotics affect the delicate balance of microbes in the gut. She has created this exhibition to help communicate the messages of the ARMORD study. Contact. Twitter. 

Travis J. De Wolfe is a PhD student in the Department of Food Science (UW-Madison). His research focuses on how probiotics, specifically strains of Lactobacillus casei, affect the microbial composition of the gastrointestinal tract in the face of nosocomial diseases like Clostridium difficile infection. He seeks to understand the mechanism by which probiotics may confer various health benefits in the face of a growing dependence on widespread use of antibiotics in humans and animals. Contact. Website. Twitter.

Elena Vinay-Lara is a PhD student in the Department of Food Science (UW-Madison). Her research focuses on cell physiology of lactic acid bacteria (LAB) and fermentations. As a part of her dissertation work, she studies pyruvate metabolism of LAB. More specifically she works on redirecting the metabolic flux from lactate to alcohols. She is also particularly interested in the study of microorganisms and their interaction with humans, not only for industrial purposes but also how they can affect human health. Contact. Website. LinkedIn.