The NIH needs to solicit and fund a massive effort to reduce, refine and replace the use of antibiotics. This is desperately needed because of the growing problem of drug resistance. Microbes become resistant to antibiotics via a kind of natural selection when the genes of the bacteria mutate and become resistant to our attempts to kill them. Thus if a person has an infection and is given antibiotics, the bacteria causing the infection might become resistant spontaneously via mutation and become the so called superbug. Thus the use of antibiotics leads to the formation of superbugs.

I am not at all suggesting that people who need antibiotics be refused antibiotics. I am suggesting ways to avoid the abuse and misuse of antibiotics.

In the USA 40,000 people die annually from antibiotic resistant bacteria and that number is rising. The numbers of patients affected by such infections and the costs for taking care of these people becomes staggering totaling in the billions annually. The signs indicate that the incidence and impact of superbugs is growing, so we need to mobilize now to head off a potentially devastating health crisis.

The best way to prevent superbugs from being produced is to not give them an opportunity to be formed. That is done by avoiding the misuse of antibiotics. The ways to avoid using antibiotics can be: prescribe only when needed, prescribe only what is needed, and prescribe alternates. While this sounds simple on the surface, to do these things will require research and education. Educating physicians and patients because they will need to modify the behavior of people who have come to depend upon antibiotics because of the outdated thought, “they cannot hurt” the patient. Well, the patient may not be directly hurt by the antibiotics except that the use of that antibiotic may be giving a bacterium a chance to be gain resistance. Further, that patient may become dependent upon using antibiotics and not train their immune system to respond when needed.

One example that is an unfortunately common scenario is the patient suspected of meningitis. If a patient sees a physician for a suspected meningitis infection the physician will do the usual diagnostics including culturing spinal fluid. But the culture can take days to bring back a result. In the interim the physician will prescribe poly-potent antibiotics to prophylacticly treat the meningitis. When the results of the cell culture come back if negative the antibiotics were not needed. If the result is an infection the physician can focus the antibiotic to treat that infectious agent. This sequence of events is absolutely good clinical practice for the patient but devastatingly risky with regard to causing the formation of a superbug.

What would be more prudent would be to be able to focus the antibiotic treatment from the first day to treat the specific bacterium causing the meningitis. That would require identifying the bacteria in minutes to hours, as opposed to days and the state of technology is not able to provide an answer that quickly. A quick diagnosis will be possible only if the NIH decides to fund research focused on providing fast answers and ways to reduce, refine and replace the use of antibiotics, which is the theme of this discussion. Again, I plead with the NIH and others in the medical and research communities to begin an initiative to stem the tide of capricious use of antibiotics.