When antibiotics fail
An expert panel chaired by CIFAR’s Humans & the Microbiome program co-director B. Brett Finlay releases its report, and warns of the dire consequences of inaction.
Bacteria that cause illnesses can adapt and change, developing an ability to evade the medicines designed to kill them. These antibiotic resistant bacteria are a public health threat directly responsible for 5,400 deaths in Canada every year. Overuse and misuse of antibiotics has led to an acceleration of resistance, and understanding the scope of this problem is a priority for governments and researchers around the world.
A new report from the Canadian Council of Academies shows that in 2018 approximately one quarter of infections were resistant to the drugs generally used to treat them. Without effective antibiotics, infections like strep throat or pneumonia can be life-threatening. The experts predict that by 2050, resistance rates are likely to climb to 40%, which may have catastrophic consequences for Canadians and for the economy.
What is the most surprising finding of the report, in your opinion?
B. Brett Finlay: The most surprising thing to me was the scale of the problem. I was certainly aware of AMR before chairing this panel, but I had no idea that resistance to first-line antimicrobials is already at 26% in this country and that by 2050 nearly 400,000 people could die in Canada (and 300 million people worldwide) from resistant bacterial infections.
What have we done wrong that has lead to this huge problem?
B. Brett Finlay: We have known about this problem since antibiotics were first developed and resistance was predicted and seen then. However, it has continued to creep and grow, and now it is getting too big to ignore, and will get even bigger.
The bottom line is that antibiotics are wonder drugs, but we have overused and abused them. This includes abuse in agriculture as growth supplements (a practice that has thankfully finally stopped in Canada), overuse in healthcare as doctors overprescribing (for example by giving antibiotics for a viral ear infection), or misuse by the public by not taking the antibiotics for the appropriate length of time or shopping doctors until one who will give a prescription is found.
What can we do to combat antimicrobial resistance?
B. Brett Finlay: There are four general areas of action that we recommend in this report:
- Increased surveillance. We must understand the problem if we want to be equipped to deal with it.
- Increased stewardship. We must treasure antibiotics and use them only for infections that really need them.
- Better infection prevention and control. We must continue with good practices like hand washing and using masks in hospitals.
- More research and innovation. We must encourage new research towards alternatives to antibiotics.
Paint a picture of a future where we turn it around and manage to get AMR under control.
B. Brett Finlay: We can look to the Scandinavian countries for inspiration, where they have put a huge effort into the strategies I mentioned. They have wrestled rates of resistance to around 10% (we are at 26%) through a huge effort.
I am involved in a great study in BC, where we reduced antibiotic use in kids 0-1 year old from 70% to 38%. This reduced asthma rates by 26%, translating to 1,250 fewer asthma cases per year in BC alone.
Why is the CIFAR program you co-direct, Humans & the Microbiome, so important in the context of increasing antimicrobial resistance?
B. Brett Finlay: Our CIFAR program studies the interactions between humans and our microbes. We know these microbes have profound effects on human health and disease. Antibiotics indiscriminately carpet bomb microbes, and they have many effects on our microbes and the diseases we develop.
For example, antibiotics early in life cause significant increases in asthma, allergy, and obesity rates, and later in life are linked to anxiety and depression. Thus, understanding the relationship between ourselves and our microbes allows us to be better informed about how antibiotics work, about the social consequences, as well as what we should do about infections.
What is the one message you would like people to take away from this report?
B. Brett Finlay: Treasure antibiotics. They are wonder drugs when used appropriately, and should not be abused.
Here are a few pieces of advice on how to treasure antibiotics:
- If you are told to wait a day to see how an infection pans out, trust your doctor and wait a day.
- Don’t use antibacterial hand sanitizer unnecessarily, and you don’t need antibacterial cleaning agents—soap and water work just fine.
- You can use diet and exercise to improve your microbes, so you won’t need antibiotics as much!
- In kids, vaccines reduce infections, which reduces antibiotic use, decreasing the chance for resistance.
The interview above has been edited for length and clarity, with input from the interviewee.
Gerard Wright, a fellow in CIFAR’s Fungal Kindgom: Threats & Opportunities program, was also a member of the panel.
More information and a full copy of the report is available on the Council of Canadian Academies website.
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