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John Timmer - May 2, 2014 6:55 pm UTC

I grew up with a constant reminder of the pre-antibiotic world. In the 1930s, my mother was riding her bicycle in the neighborhood when she was struck by a car. Her leg, badly injured, became infected. With no way of combatting the infection, her family was left with a stark choice: lose her leg or potentially lose her life. For the rest of her life, everything below one of her knees was prosthetic.

With the rise and rapid spread of antibiotic resistance, we run the risk of returning to this era. Earlier this week, the World Health Organization (WHO) announced that "the problem is so serious that it threatens the achievements of modern medicine. A post-antibiotic era—in which common infections and minor injuries can kill—is a very real possibility for the 21st century."

In response, the WHO plans on coordinating a global effort to limit the spread of antibiotic resistance. As it notes, though, "Determining the scope of the problem is the first step in formulating an effective response." So the WHO has polled all of its member states to get a sense of what they know about drug-resistant pathogens within their borders. The results were released this week.

The report makes clear that antibiotic resistance isn't our only problem. Malaria parasites have evolved drug resistance at a number of sites, drug-resistant flu viruses have been detected, and strains of HIV that resist various antiviral therapies exist. All of these things make health care more challenging.

But at the moment, none of them are as widespread as antibiotic-resistant bacteria. Even within the limitations of poor reporting in many locations, drug-resistant pneumonia is present in all six of the WHO's global regions. Two different types of drug-resistant E. coli show up in five out of the six.

Because these and other microbes are resistant to the most common antibiotics, doctors have been forced to prescribe more and more of what the report calls "last-resort" treatments. These antibiotics are more expensive, and less readily available, and they cause more side effects. And since they're generally used only when infections are serious, the costs of treating these cases are raising the price of healthcare. Finally, the WHO also notes that strains resistant to these last-resort antibiotics have been identified, so our treatment options may become even more limited.

With a better picture of the situation in hand, the WHO intends to start developing a global campaign to limit the spread of antibiotic resistant bacteria. But even before that's developed, there are obvious things we can do to limit the scope of the problem. Foremost on this list is simply to limit infections to start with. Public health campaigns to improve sanitary practices and improve access to clean water, along with vaccinations where appropriate, should all cut down on antibiotic use. When drugs are prescribed, the treatment needs to be followed to completion.

By limiting infections, we can hopefully begin limiting the use of antibiotics, which will gradually reduce the prevalence of drug-resistant strains. But it's likely to be a long and drawn out fight, one that will produce far too many casualties.

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