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Cracks in the Foundation: Antibiotic Resistance on the Rise, Threatening Modern Medicine
A cornerstone of modern medicine, antibiotics, is facing a growing crisis as a new report from the World Health Organization (WHO) reveals a concerning surge in antibiotic resistance. Once-minor infections are becoming increasingly difficult to treat, jeopardizing life-saving medical procedures and potentially costing more lives.
Antibiotics have long been hailed for their ability to transform deadly infections into manageable conditions, making interventions like surgery and chemotherapy significantly safer. However, each use of these powerful drugs carries a risk: the emergence of antibiotic-resistant bacteria.
“Antimicrobial resistance is just basic evolution,” explains Kevin Ikuta, an infectious disease physician and researcher at UCLA. He notes that while antibiotics are essential, “we are in this battle we’re trying to lose as slowly as possible anytime we treat an infection.”
The latest WHO data indicates that humanity is losing this battle faster than anticipated. In 2023, approximately one in six infections tested globally showed resistance to antibiotic treatment. Even more alarmingly, nearly 40% of antibiotics used for common urinary, gut, blood, and sexually transmitted infections have lost their effectiveness over the past five years.
“Frankly, it’s quite concerning,” states Ramanan Laxminarayan, president of One Health Trust, a non-profit organization. “We do see increases in resistance every year, but here we see a pretty sharp increase.”
Antimicrobial resistance is already a significant global health threat, directly contributing to roughly 1.2 million deaths annually and playing a role in nearly 5 million. Laxminarayan warns that this toll is likely to escalate, declaring, “We’re sleepwalking into a disaster. I shouldn’t say we are – we already have sleepwalked into a disaster.”
Resistance Hot Spots
The report highlights that the sharpest increases in resistance were observed in low- and middle-income countries, often those with less robust healthcare systems. Countries with weaker surveillance for antibiotic resistance also tended to report higher levels.
“For some of the most common infections that afflict tropical countries, nearly 50 to 60% of the infections are now drug resistant,” says Laxminarayan.
While these higher figures could be influenced by biased data – where weaker surveillance systems primarily detect the most severe, often resistant, infections – they also likely reflect genuinely higher levels of resistance. “It’s probably both,” Laxminarayan concludes.
He points out that weak surveillance often correlates with weaker health systems, leading to “less infection prevention and control, less vaccination, weaker water and sanitation system,” all of which can foster resistance. Easier access to basic antibiotics without prescriptions in some countries also contributes to misuse, such as treating viral infections with antibiotics, giving resistant bacteria an unnecessary advantage.
The Paradox: Less Access, More Resistance
Paradoxically, while misuse is a problem in lower-income countries, a larger issue is the lack of access to effective antibiotics, particularly the advanced drugs available in wealthier nations when first-line treatments fail.
“In the U.S., if the first two drugs didn’t work for you, likely you could afford the third drug,” Laxminarayan explains. “That option is not available to someone living in Cote d’Ivoire or The Gambia.” This disparity can lead to insufficient treatment of infections, further fueling the cycle of resistance.
These dynamics are driving increased resistance in commonly prescribed broad-spectrum antibiotics, including carbapenems and fluoroquinolones. As resistance to these first-choice drugs grows, physicians are forced to rely on older, potentially more toxic medications, or newer drugs that are not widely available, especially in lower-income settings.
“So we’re either left with an untreatable infection or with a treatment where the side effects may be as toxic as the infection itself,” Ikuta notes. “It’s quite the pickle, clinically.”
A Path Forward, But Time is Ticking
Escaping this “pickle” will require a concerted global effort. Improved global surveillance is crucial to gain a clearer picture of resistance patterns.
Despite more countries submitting data to the WHO, significant gaps remain; last year, 48% of countries provided no resistance data, and nearly half of those that did still lack robust surveillance systems. Better data can guide physicians in selecting more effective treatments and minimize resistance development.
The development of new, innovative antibiotics is also essential. However, the WHO reports that the current pipeline of new treatments is insufficient to meet the urgent need.
Ikuta warns that time is running out. If progress isn’t made and resistance continues to escalate, fundamental aspects of modern medical care that we currently take for granted could be jeopardized.
“It’s not just the treatment of acute infections and sepsis, it’s making sure surgery is safe and effective, and chemotherapy is available,” he emphasizes. “These advancements in medicine are on the back of antibiotics, so when we lose antibiotics, we risk losing those.”