Are We Headed Back to the Pre-Antibiotic Era?

From the Lecture Series: An Introduction to Infectious Diseases

By Barry C. Fox, M.D., University of Wisconsin

In a recent 2017 report from the Centers for Disease control (CDC), an alarming medical case was reported: “the Washoe County Health District in Reno, Nevada, was notified of a patient at an acute care hospital with carbapenem-antibiotic-resistant bacteria that was resistant to all available antimicrobial drugs. The patient was placed in a single room under contact isolation precautions.

Antibiotic Resistance word
(Image: Papa Annur/Shutterstock)

The patient had a history of recent hospitalization outside the United States in India.” Unfortunately, she died from this drug-resistant bacteria. The CDC estimates that drug-resistant bacteria cause two million illnesses and approximately 23,000 deaths each year in the United States alone.

This is a transcript from the video series An Introduction to Infectious Diseases. Watch it now, on Wondrium.

The death of this Nevada woman in August of 2016, and highlighted in the CDC report, represents an opportunity to consider what the next pandemic will be. The possibilities include bacterial and viral threats and include the multiple drug-resistant bacteria, “New Delhi” strain, resistant to all antibiotics, which was the cause of the patient’s death. 

This highlights the importance of understanding that diseases can cross continents within 24 hours. The arrival into the U.S. of SARS, MERS, and EBOLA—all deadly viruses—makes the threat of infectious disease pandemics a reality in the U.S. More recently, the spread and invasion of ZIKA virus in Florida provides us with another reminder of newly emerging infectious diseases, which will take time to fully understand.

Learn more: Outbreak! Contagion! The Next Pandemic!

Image of doctor holding antibiotics
We have an expanded social responsibility to take antibiotics only when needed, and to take them as prescribed, in order to prevent emerging antibiotic resistance. (Image: Alexander Raths/Shutterstock)

Returning to antibiotic resistance, it is important to point out that when individuals take antibiotics, it is not just an individual decision to take them. We have an expanded social responsibility to take them only when needed and to take them as prescribed, to prevent emerging antibiotic resistance.

In 2014, President Obama issued Executive Order #13676 to combat antibiotic-resistant bacteria. In March of 2015, a comprehensive plan entitled the National Plan for Combating Antibiotic Resistance was released. It was intended to provide a roadmap to navigating the nation regarding the challenge of the increase in antibiotic-resistant bacteria. This will form the basis for the rest of this discussion on antibiotic resistance. The goals of his five-year national action plan are to:

Goals of President Obama's action plan to combat antibiotic resistant drugs

The plan lays out specific milestones for achieving the action plan goals. It also introduces the concept of “One Health”—that disease and antibiotic resistance can arise in humans, animals, and the environment, and these are all intertwined. You might be surprised to know that 75 percent of all antibiotic use is in veterinary medicine. Over the past 50 years, efforts to curb antibiotic use as growth promoters in animals has been challenging. Recently, however, bill HR-1552—the Preservation of Antibiotics for Medical Treatment Act of 2015—was passed and is intended towards accomplishing this goal. This phases out the use of antibiotics in veterinary medicine for non-routine disease control.

Learn more about milestones in infectious disease history

Another goal contained in the plan is to develop a rapid diagnostic “point of care” test to distinguish between bacterial infections where antibiotics might be useful and viral ones where they are not. Antibiotics are still prescribed for 65 percent of primary care visits for presumptive bacterial respiratory infections, but only 10-15 percent of the time are they bacterial. Imagine going to your medical provider and having such a test available in their office to avoid overprescribing of unnecessary and potentially harmful antibiotics that may have detrimental side effects?

Imagine going to your medical provider and having such a test available in their office to avoid overprescribing of unnecessary and potentially harmful antibiotics that may have detrimental side effects.

Efforts to accomplish goal #1 to slow the emergence of antibiotic-resistant bacteria include the concept of “antibiotic stewardship”. This means responsible use of antibiotics. Programs within hospitals have existed for the past 15 years, including my job at the University of Wisconsin to monitor antibiotic use.

Nearly 50 percent of patients entering hospitals receive one or more antibiotics, but after review, nearly 50 percent of that antibiotic use was deemed “unnecessary”. For the first time, the government’s Center for Medicare Services requires all hospitals that receive reimbursement from Medicare to have a hospital antibiotic stewardship program.

Learn more: Antibiotics: A Modern Miracle Lost?

Image of pharmaceuticals antibiotics pills medicine
The CDC announced in the fall of 2016 that healthcare systems need to establish outpatient antibiotic stewardship programs to reduce inappropriate antibiotic prescribing. (Image: nokwalai/Shutterstock)

The CDC also announced in the fall of 2016 that healthcare systems need to establish outpatient antibiotic stewardship programs to reduce inappropriate antibiotic prescribing, such as the overuse for respiratory infections. While the CDC had an existing program known as “Get Smart” about antibiotics for nearly 20 years, the program has had limited national success in its implementation. With the announcement this fall proclaiming goals for outpatient antibiotic stewardship, the plan is to “get smart, and get tough” on outpatient antibiotic use, and make sure it is necessary.

We now have a moral obligation to use antibiotics more wisely than ever before for many reasons. They are only beneficial under some circumstances and have real risks of side effects. From a societal perspective, inappropriate utilization is leading to “superbugs” and a possible return to the pre-antibiotic era, where we will have no drugs to treat the pathogens. With this information, we can give antibiotic utilization serious consideration in the future.

Common Questions About Antibiotic Resistance

Q: How does antibiotic resistance happen?

Antibiotic resistance takes place when bacteria adapt to the drugs that are used against them, rendering the drugs ineffective.

Q: What infections are antibiotic resistant?

Antibiotic resistant infections include staph infections, Streptococcus pneumonia (causes pneumonia and meningitis), E. coli, and Salmonella.

Q: Does antibiotic resistance go away?

Once you develop antibiotic resistance, it is very difficult to get rid of it. This is because all it takes is for one bacteria to become resistant and then it can give birth to new resistant bacteria.

Q: How can we prevent antibiotic resistance?

To prevent antibiotic resistance, you should only use antibiotics when it is absolutely necessary. You should not take antibiotics for a cold or the flu as they will not help you get better and will probably harm you in the long run as you are more likely to develop resistance.

This article updated on April 16, 2020

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1 Chen L, Todd R, Kiehlbauch J, Walters M, Kallen A. Notes from the Field: Pan-Resistant New Delhi Metallo-Beta-Lactamase-Producing Klebsiella pneumoniae — Washoe County, Nevada, 2016. MMWR Morb Mortal Wkly Rep 2017;66:33. DOI:
3 National Action Plan for Combating Antibiotic-Resistant Bacteria 2015
CDC. Core Elements of Outpatient Antibiotic Stewardship. MMWR 2016: 65 (6)