After Antibiotics Stop Working, What's Next?

By Paul DiCorleto, Ph. D.

Cleveland Clinic

Each year in the United States, 23,000 people die from drug-resistant bacterial infections.

Antibiotics, designed to fight infections, have been one of the greatest medical advances of the past 100 years. But many health experts warn that we are entering a postantibiotic era, where drug-resistant “superbugs” threaten our health and economy.

Our behavior — how we use antibiotics and antibacterial products — may be part of the problem.

How superbugs survive

Genetic mutations randomly occur in nature. Bacterial genes mutate rapidly in millions of different combinations. Every so often, they get the right combination that helps them adapt to an environmental change — like the presence of an antibiotic. When that happens, only the cells containing the mutation will survive. With their competitors out of the picture, these antibiotic-resistant cells multiply quickly, becoming stronger and often deadlier.

This “survival of the fittest” process becomes accelerated when we overuse antibiotics as medication, in our food or even on our skin.

Unfortunately, many people take antibiotics to treat viral infections like the flu or common cold. Antibiotics have no effect on these illnesses, but in a 2012 study, 36 percent of Americans believed antibiotics could treat the common cold. This misconception is dangerous. Antibiotic overuse can lead to drug resistance — not only in yourself but also in communities.

This is where you have the best chance to help fight superbugs. Before taking antibiotics for something that may not be bacterial in nature, ask your doctor if you really need them. And if you know someone who frequently takes antibiotics for simple sneezes and sniffles, let them know they could be endangering themselves and their loved ones.

The concern is not just for antibiotics, either. The FDA recently announced it will take a closer look at “antibacterial” products such as soaps, body washes and hand sanitizers. These products will be monitored for safety and to determine if they are actually more effective at killing bacteria than soap and water.

Drug-resistant bacteria are especially prevalent — and dangerous — in hospitals, nursing homes and other healthcare facilities. The Centers for Disease Control report that multi-drug-resistant bacteria called CRE (carbapenem-resistant Enterobacteriaceae) are rapidly rising. These superbugs are resistant to nearly all existing antibiotics; they kill 50 percent of people with infections in their blood. Another hospital-related pathogen, Clostridium difficile (C. diff), is becoming more deadly due to drug resistance. C. diff deaths have quadrupled in the last 10 years.

How do we fight this deadly trend? We just need to make more antibiotics, right?

It’s not that simple. The pipeline of new antibiotics has dried up considerably since the early 1990s, and the number of pharmaceutical companies investing in antibiotic research has dwindled to four.

However, some researchers are developing the next generation of antibiotics by studying and exploiting our natural defense mechanisms.

For example, Carol de la Motte, PhD, of the Lerner Research Institute, Cleveland Clinic, found that hyaluronan (HA), a natural substance found in human breast milk, acts to protect the body from bacterial infections in the intestines. HA revs up production of several naturally made antibiotics, called antimicrobial peptides, in the intestine. She also found that HA protects against Salmonella — the sometimes deadly bacteria associated with food poisoning. She also is studying its effects on C. diff.

Further studies are needed, but HA shows great potential for preventing intestinal infections in high-risk individuals, such as world travelers and nursing home patients. Because HA is a natural substance, bacteria are not likely to develop a tolerance or resistance to it.

Other antimicrobial peptides have returned to the spotlight recently for potential clinical use. More than 2,000 peptides are currently available for study. And a group of researchers at the University of Pittsburgh has designed antimicrobial peptides in the laboratory and shown that they can kill multi-drug-resistant pathogens. These engineered peptides may offer a viable alternative to traditional antibiotics.

Superbugs are a major threat to global health, but with rigorous education and innovative research, we still have a chance to beat them.

As Chair of the Lerner Research Institute, Paul DiCorleto, PhD, oversees all laboratory and clinical research at Cleveland Clinic. He is an expert in cardiovascular biology.

Reprinted with permission from health.clevelandclinic.org. For more information, check health.cleveland clinic.org.