A patient walks into the doctor’s office complaining of a sore throat, headache, and 103-degree fever. After an examination, the doctor performs an in-house flu nasal swab, COVID test, and Streptococcus culture. These three tests come back negative, and the patient is sent home with the diagnosis that their affliction is “probably something viral” and the directive to “keep an eye on things.” A few days later, the high fever persists and the symptoms have worsened, so the patient returns. This time, the doctor collects a small blood sample from the patient’s finger and completes an in-house CBC, or complete blood count, with a differential. The CBC shows a high neutrophil count, or high levels of immature white blood cells. The doctor now realizes that the infection is bacterial, and prescribes their patient antibiotics. In this case, the doctor did everything correctly, but let’s discuss a different scenario: a patient enters the doctor’s office with a runny nose, cough, sore throat, and fever. This patient is about to go out of town and doesn't want to get her grandmother sick, so the doctor writes her a prescription for an antibiotic “just in case,” which the patient decides to fill and begin taking right away. However, this patient only has a cold virus, and both she and her doctor are now complicit in allowing antibiotic resistance to flourish.
A novel, deadly threat is looming on the horizon of the medical realm: the superbug. Bacteria that have evolved antimicrobial resistant properties are quickly outpacing our existing antibiotic development, necessitating novel research to combat these infections. From an evolutionary standpoint, the competition between antibiotics and bacteria is like an arms race, in which through natural selection, the strongest bacterial strains survive and must be met with stronger antibiotics. It is a continuous and vicious struggle, comparable to the clash between an unyielding cockroach and the newest slew of pesticides. For this reason, a reactive approach to antibiotic development may fall short in the superbug fight, meaning engineering drugs to respond to new, deadly mutant strains only after they manifest will likely never allow scientists to beat antibiotic resistance. In her novel The Plant Hunter, Cassandra Quave predicts that the number of deaths attributed to antimicrobial resistance will exceed those due to cancer by the year 2050. She is a scientist who, as is aptly mentioned in her book’s title, hunts for plants with antibiotic properties like Rubus fruticosus, a species of blackberry. She brings attention to the fact that too few companies and scientists are giving necessary attention to the crisis, and even fewer are focused on the economic component that is necessary to support the search for the next penicillin-like breakthrough. So what is there to be done?
Some bacteria have evolved beyond the scope of treatment due to the use of antibiotics in the livestock industry, where they are intended to prevent outbreaks in close-quarter animal stalls. They are dispensed in low doses, whether by food or drink, to the animals whose meat eventually lands on our table and may confer the same resistant bacterial strains onto the consumer. Strong strains of E. Coli may essentially feed on this low-level dosage that won’t kill them but instead allow them to build complete resistance to the antibiotic and proliferate.
In the physician setting, overprescription of antibiotics is also running rampant. Many patients who come into the office with an unexplained illness want any form of medication they can get their hands on, even if their affliction is not bacteria-based. In addition, their appointments may be put on a time constraint within a busy day of patient visits, perhaps leading to incorrect and rushed diagnoses. This overprescription is highly dangerous because antibiotics are ineffective against viruses and may promote the growth of resistant strains of bacteria instead. Another example comes from the dentist’s office, where some dentists prescribe antibiotics prophylactically prior to an oral surgery for patients with underlying health conditions. Though this may be necessary to prevent infections in immunocompromised patients, use of antibiotics without an infection to treat may needlessly wipe out the microbiome and subsequently target the immune system it was intended to protect.
Beyond inappropriate antibiotic prescription by medical officials, this crisis also underscores a lack of efficient tests and differentials necessary to provide timely details about patients’ infections. For example, new methods are arising to combat overuse of antibiotics by properly identifying the strain of virus or bacteria affecting a patient, but these tests often come as out-of-pocket expenses. However, these rapid tests are extremely beneficial in that they aid physicians in deciding whether or not to prescribe antibiotics and counteract the often too hasty decision-making process. These tests aim to highlight specific biomarkers that indicate whether an infection is bacterial rather than viral, and shorten the sometimes days-long waiting period required to receive results. We discussed the CBC or complete blood count, which helps to categorize infections by white blood cell counts, where elevated levels point towards bacterial and lower levels viral. However, these tests are not always 100% accurate. The same applies to PCR tests, which help amplify the genetic material of a sample to pinpoint its identity. However, these may take up to a day or more for results. Laboratories are in the throes of the race to develop tests with more rapid turnaround rates utilizing biomarkers like CRP and PCT, according to the National Institute for Health and Care Research. Tests like these may ensure that patients leave the doctor’s office with an accurate diagnosis in hand.
Continuing education for new and existing physicians about the dangers of overprescription is integral to fighting further evolution of resistant strains. Additionally, it is essential to highlight the demand for the development of rapid, accurate, and inexpensive in-house testing in the doctor's office by laboratories like Pfizer. A transition from antibiotics to prebiotics, probiotics, and DFMs, or direct-fed microbials, in the livestock industry has also demonstrated great strides in the maintenance of animal health without the promotion of resistance. Beyond these, prolonged research into powerful biological tools like bacteriophages and medicinal plants may prove to be the most instrumental in mitigating the resistance crisis.