Our options for fighting superbugs are dwindling

Imagine the following scenario: You discover that you have an infection — perhaps appendicitis, an abdominal infection or a urinary tract infection. You go to the doctor to get antibiotics, but your doctor tells you that oral antibiotics are no longer effective.

Your only option for treatment is to spend a week in the hospital on IV antibiotics. 

That could be the near future of healthcare, according to Brad Spellberg, the chief medical officer at USC Medical Center in Los Angeles. As bacteria are becoming more and more resistant to antibiotics, we are running out of options for treating so-called “superbugs.”

“It’s getting very alarming,” Spellberg says. “We’re now seeing community bacteria not in health care settings causing community onset infections. … They’re resistant to everything. We have IV antibiotics left for them, but they’re resistant to everything oral.” 

And the problem is worse than that. Last week, the US Army announced the arrival of a new enemy on American soil. But the danger was microscopic: a bacterial gene, easily passed to other bacteria, which confers resistance to one of our last-ditch antibiotics, colistin. The news was a reminder of our dwindling options. 

“We aren't getting new [antibiotics] developed at nearly the rate they used to be, because the science is increasingly difficult. The economics are not favorable for a variety of reasons to do antibiotic discovery — and the regulatory environment has been very hostile to new antibiotic development,” Spellberg says. “On top of that, resistance continues to spread because we continue to so badly abuse antibiotics and overuse them.”

There are, however, a few researchers who are turning to older methods to fight superbugs. Among them is Paul Turner, a professor ecology and evolutionary biology at Yale University. Turner is experimenting with viruses, called phages, that attack bacteria and weaken them until they’re unable to fight antibiotics. 

“This is an old idea that basically is gaining resurgence,” Turner says. “You use phages, which are bacteria-specific viruses to target the bacteria instead of chemical antibiotics. So the trick is that phages, just like traditional antibiotics, the bacteria can gain resistance to them. … They simultaneously become more sensitive to antibiotics that are actually in our current drug arsenal. So, we’ve found a way to turn old antibiotics that are continuing to be less and less efficacious and useful and now we're able to to sort of use those still, in combination with phages.”

Still, in addition to developing new types of antibiotics, and new ways of fighting superbugs, Spellberg says there are other things we should be doing to avert an antibiotic resistance crisis. 

“We need to do a much better job of protecting the antibiotics we currently have,”  Spellberg says. “We need to figure out how to get new antibiotics developed and we need to think of new ways to treat infections that don't try to kill the bacteria. Resistance occurs because we apply selective pressure by trying to kill the bacteria. … If we could treat infections without killing the bacteria directly, you might have a way to treat infections that's less prone to inducing resistance.”

There is also a movement to decrease the amount of antibiotics used not only by humans, but used for livestock as well. 

“Four times as many antibiotics are purchased for use in livestock as for use in human beings in the United States,” Spellberg says, “It is true that we cannot say definitively what proportion of resistant infections in humans is attributable to the use of antibiotics in animals, but we can say there is a contribution. And so societally, rather than getting into a debate on the minutia of exactly what proportion of this causes that, the point really is, since we know it contributes and that's a serious societal negative or con, what is the pro that it offers society that should allow us to want to put up with that call?”

So what can you do to make sure you develop resistance to antibiotics as slowly as possible? Here are the top three suggestions: 

1. Wash your hands. This is the simplest way to prevent disease and infection.

2.  Get your vaccines. Vaccines protect people who have been infected with certain diseases and protect people who come in contact with those who have diseases.

3. Handle your food properly. Cook meat thoroughly to eliminate resistant bacteria and clean hands and surfaces after preparing meat. 

This article is based on an interview that aired on PRI's Science Friday.