The Complex Emergence of Superbugs

Drugs and Clinical Trials CategoryEveryone seems to be concerned about drug-resistant bacteria, or so-called “superbugs” these days, and with good reason. Physicians are seeing an increasing number of infections resistant to their usual antibiotic armamentarium, and are losing lives that just a few years ago would have been salvageable, including the recent death of a top Brazilian model.

Search the literature for reasons why this is happening and you’re likely to stumble across an array of sources that point the finger at over-prescribing physicians and misbehaving patients who don’t take their antibiotics as prescribed. Certainly these two factors play a significant role. But what is frequently overlooked is how drug resistance may be fostered outside the hospital and doctor’s office.

FarmTake, for example, factory farming. Each year in the United States, the farming industry uses 25 million pounds of antibiotics, representing 70% of America’s antibiotic usage, not just to treat infections, but also to prevent them so that their livestock can survive their feedlots long enough to get to slaughter. In 2001, the AMA issued a statement opposing this practice. In 2004, the FDA officially discouraged this practice but backed off from this position in July of 2008.

Then there’s the issue of lax oversight of production and disposal of antibiotics. There was a recent article documenting the presence of ciprofloxacin, a broad-spectrum antibiotic that was once one of the medical community’s “big guns”, in the effluvia of a medication production plant in India in concentrations high enough to treat 90,000 people. When the companies that utilized this plant were questioned about this finding, they stated that the issue of pollution in India was “not within the scope of the activities” of their group. And an Associated Press investigation last year found not only the antibiotic tetracycline, but also blood pressure medications, steroids, cholesterol medications, and antidepressants in Philadelphia’s drinking water, presumably due to the practice of flushing unused medications down the toilet.

Finally, the pharmaceutical industry shifted its attention elsewhere. Research and development funds began being diverted away from the realm of antibacterials in the 1980’s, focusing more on anti-retrovirals for the newly emerging HIV epidemic and higher-order cardiovascular medications. Only in recent years has the attention once again swung back to developing medications to attack the resilient bacteria that have rendered antibacterial efforts of previous decades obsolete.

So while both physicians and patients need to exercise caution in the prescription and consumption of antibiotics, a true attack on drug-resistant bacteria may require a more comprehensive approach addressing not only medical, but also environmental, societal, and industrial factors.


J. Stephenson (1998). Antibiotics and Livestock JAMA: The Journal of the American Medical Association, 280 (7), 594-594 DOI: 10.1001/jama.280.7.594-a

T. A. McNamee, MD

T. A. McNamee, MD, is an associate professor and internal medicine residency program director at Sanford School of Medicine of the University of South Dakota.
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