“We’re doomed to repeat the past no matter what. That’s what it is to be alive. It’s pretty dense kids who haven’t figured that out by the time they’re ten.” Kurt Vonnegut, Bluebeard

“Those who don’t know history are destined to repeat it.” Edmund Burke

Antibiotic resistance has been occurring for billions of years and will keep on happening (NEJM 2013; 368: 299-301).  This commentary offers a different perspective and indicates that Kurt Vonnegut’s quote is more appropriate for this post.  Some key points:

• “We live in a bacterial world where we will never be able to stay ahead of the mutation curve.” We will run out of targets to attack microbes.
• Bacteria “invented” antibiotics billions of years ago, and “resistance is primarily the result of bacterial adaptation to eons of antibiotic exposure.” Thus, even with good antimicrobial stewardship, resistance will still occur.
• Antibiotic resistance has been identified in bacteria found in underground caves that have been geologically isolated from the planet surface for four million years.
• In 1945, Alexander Fleming called for stopping the overuse of penicillin to slow the development of resistance.
• In 2009, three million kilograms of antibiotics were administered to humans and 13 million kilograms to animals.

Possible useful steps: more vaccines to prevent infections, smaller antibiotic clinical trials, use of rapid biomarkers to withhold antibiotics from those without bacterial infections, stopping antibiotics to help livestock growth, better waste-treatment of antibiotics, ‘self-cleaning’ hospital rooms, and better drug delivery to avoid foreign materials in intensive care patients.

Related blog entry:

• Preventing lethal antibiotic resistant outbreaks | gutsandgrowth