Dr. Arjun Srinivasan: We’ve Reached “The End of Antibiotics, Period”
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Dr. Arjun Srinivasan: We’ve Reached “The End of Antibiotics, Period”

Dr. Arjun Srinivasan: We’ve Reached “The End of Antibiotics, Period”

October 22, 2013
FrontLine / PBS

 

Dr. Arjun Srinivasan is an associate director at the Centers for Disease Control and Prevention. He spoke with FRONTLINE about the need for more action at the local level to combat  the problem of antibacterial resistance. This is the edited transcript of an interview conducted on June 28, 2013.

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Explain to me why the discovery of antibiotics was so important for medicine.

Antibiotics were one of [the most], if not the most, transformational discoveries in all of medicine. Infections are something that we struggled to treat for many, many years, for centuries before the advent of antibiotics, and infections were a major cause of death before the advent of antibiotics.

So with the discovery of this new class of drugs, we overnight had an ability to care for people and offer them not just a treatment but a cure for an illness that previously would have taken their lives in a rapid manner. …

They really are miracle drugs, and not only have they saved the lives of millions and millions of people … but antibiotics have opened up new frontiers in medicine that would be impossible without them.

Like what?

For example, organ transplantation. One of the major causes of death in patients who would have an organ transplant would be an infection. Without antibiotics, we wouldn’t be able to treat any of those infections.

And stem cell?

Stem cell transplants, bone marrow transplantation, cancer chemotherapy would be largely impossible … because all of these are therapies that weaken people’s immune system, which of course makes them then vulnerable to infections. We don’t have to worry about that so much because we have antibiotics that can treat those infections.

A lot of the therapies that we use now for different types of arthritis, like rheumatoid arthritis — you see ads for that now on television — again, these are therapies that weaken immune systems. They make people vulnerable for infections, but because we have antibiotics, that’s not something that we have to particularly worry about as much as if we didn’t have the antibiotics.

So they have really transformed the practice of medicine, perhaps unlike any other drug that’s available to us.

…How does resistance work, and why is it a problem?

Bacteria, like any living organism, want to survive. They are adapted that way, and any successful bacteria is the bacteria that’s most able to survive in the environment. So bacterial resistance is largely inevitable, because bacteria will always change in order to survive.

So anything that we do to try and kill bacteria, or anything the environment does to try and kill bacteria, bacteria will eventually discover ways or find ways around those.

It’s important to know that this is a phenomenon that plays out in nature. Most of the antibiotics that we have available to us now were derived from products in nature. So penicillin was an agent that was excreted by molds in order to kill bacteria. Eventually bacteria will evolve, and they’ll adapt ways around that to overcome that obstacle.

There are lots of bacteria. They have the advantage on us in terms of numbers. And whenever you have that many of an organism, it’s likely that one among them will be resistant to an antibiotic.

If you use an antibiotic, then that one among the group that is resistant becomes the predominant one. So resistance is something that is an inevitable consequence of bacterial evolution. But it’s also something that we have certainly helped along the way.

We’ve helped it?

We’ve helped it, absolutely, by the overuse and the misuse of antibiotics, and this is something I think that we have to own up to. We’ve fueled this fire of bacterial resistance.

These drugs are miracle drugs, these antibiotics that we have, but we haven’t taken good care of them over the 50 years that we’ve had them.

Continue reading at Dr. Arjun Srinivasan: We’ve Reached “The End of Antibiotics, Period” | Hunting the Nightmare Bacteria | FRONTLINE | PBS.

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