With input from Dr Monica Vasudev

1323: AMR the Next Concern after COVID-19

1. New antibiotic development cannot keep up with the rate of bacterial resistance, thus giving rise to the antimicrobial resistance crisis.
2. There is a smaller market size and profit incentive for pharma companies for developing new antibiotics in comparison with lifestyle medications and other therapies that have broader indications. Therefore, the number of new antibiotics approved by the FDA annually has reduced.
3. While earlier it took an average of 21 years for bacteria to become resistant when antibiotics were first used, it takes just 1 year on average today to develop resistance against a drug. The CDC has listed 18 different types of antibiotic-resistant bacteria and has classified five as urgent threats to human health.
4. Carbapenem-resistant Enterobacteriaceae (CRE) are one of the most concerning mutating bacteria. Mortality due to CRE infection has been estimated to be as high as 40-50%. Antibiotic-resistant bacteria in the healthcare setting, including CRE and methicillin-resistant Staphylococcus aureus, account for more than 85% of the antibiotic-resistant deaths, suggests the CDC analysis.
5. Up to 30% of patients with severe C. difficile colitis and sepsis need emergency surgery, and the mortality among patients undergoing surgery is high.
6. Overuse of antibiotics is the key factor behind antibiotic resistance today.
7. The CDC has stated that in 2018, seven antibiotic prescriptions were given for every 10 Americans. One-third of these were considered unnecessary, and frequently were for viral illnesses that are not responsive to antibiotics, including sinus infections, ear infections, viral sore throats, and common cold. Clinicians who write such prescriptions often argue that giving the antibiotic would be of help there is a small bacterial component involved or if the infection gives rise to an opportunity for bacterial infection.
8. The overuse of antibiotics has been apparent in the treatment of COVID-19.
9. A meta-analysis published in the Journal of Clinical and Infectious Diseases, including 18 studies that involved 2,010 hospitalized COVID-19 patients, reported that 72% of the patients got an antibiotic, despite the fact that only 8% of them had a bacterial co-infection. Azithromycin was frequently prescribed early in the pandemic as some questionable evidence suggested that the drug had an antiviral effect.
10. Antimicrobial resistance might be worsening during the ongoing pandemic.
11. Nearly 70%-80% of all antibiotics in the U.S. are given to animals; crowded conditions aid mutations. As the animals develop drug resistance, it can spread to the environment and reach our food. It can subsequently be transferred to people who eat that food.
12. Antibiotic use is also rampant in salmon farms. It is a matter of concern as 90% of fresh salmon eaten in the U.S. comes from farms.
13. Responding to the increasing resistance threat in the food industry, some fast food chains have moved to antibiotic-free animal products. Many fast-food chains have shown progress in limiting the use of antibiotics in chickens. The public interest group PIRG has developed a scorecard that compares antibiotic practice patterns of fast-food chains and can help guide consumers away from the companies that use antibiotics.
14. In 2017, the use of antibiotics to promote growth in livestock was banned by the FDA.

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA