We Are Overdosing on Antibiotics

There really is such a thing as too much of a good thing. The Greeks reminded us centuries ago that we should look for balance, and they were right. The recent discussion has been with respect to too much in the way of pain killers, which then leads to addiction, overdose, and suicide. Now, once again, the alarm is being raised about the overuse of antibiotics. Almost three years ago, the Centers for Disease Control issued a report about this problem, as I discussed at the time. This week's Economist reports on a new study put out in the UK by the Wellcome Trust raising the warning flag yet again.

Alexander Fleming, who first noticed penicillin’s effects, warned of the dangers of resistance almost as soon as the drug had been shown to be a success. But the fact that these are old worries does not mean that they are not serious ones, nor that they cannot get worse. This week sees the publication of the final recommendations of a review on resistance to antimicrobial drugs led by Jim O’Neill, formerly chief economist at Goldman Sachs, on behalf of the British government and the Wellcome Trust, a medical charity. According to Lord O’Neill and his colleagues 700,000 people die each year from infection by drug-resistant pathogens and parasites. And they say that if things carry on as they are that figure will rise to 10m by 2050, knocking 2-3.5% off global GDP. Already the cost to the American health-care system of dealing with infections resistant to one or more antibiotics is $20 billion a year.

As the Economist points out, we know what to do, even if the solutions are not simple (just as with the pain-killer issue), but we have to get busy.

Because antimicrobial resistance has no single solution, it must be fought on many fronts (see article). Start with consumption. The use of antibiotics to accelerate growth in farm animals can be banned by agriculture ministries, as it has in the European Union. All the better if governments jointly agree to enforce such rules widely. In both people and animals, policy should be to vaccinate more so as to stop infections before they start. That should appeal to cash-strapped health systems, because prophylaxis is cheaper than treatment. By the same logic, hospitals and other breeding grounds for resistant bugs should prevent infections by practising better hygiene. Governments should educate the public about how antibiotics work and how they can help halt the spread of resistance. Such policies cannot reverse the tragedy of the commons, but they can make it a lot less tragic.

Taking no action will almost certainly slow, if not reverse, the global improvement in life expectancy that took place after penicillin was shown to be so effective during World War II.