The development of antibiotics in the middle of the 20th century was one of the greatest achievements of modern medicine. Penicillin and its pharmaceutical cousins saved millions of lives. But like a magic potion given to the world by a stern fairy, antibiotics come with a catch — If you abuse them, you lose them.
For decades, scientists have been warning that antibiotic resistance is on the rise globally because of misuse of the drugs.
But a new report makes it clear that the world is not listening.
Between the year 2000 and 2015 human consumption of antibiotics globally rose 65 percent — to an astounding 42 billion doses a year. "We wanted to examine global use of antibiotics because once resistance emerges in one place it can spread anywhere," says Eili Klein, a fellow at the Center for Disease Dynamics, Economics and Policy in Washington and the lead author of the new report, which was published Monday in the Proceedings of the National Academy of Sciences.
Along with his colleagues Klein found that there was a dramatic rise in antibiotic use over the last 15 years in low- and middle-income countries.
"A place like India, which has one of the highest populations in the world, saw enormous gains in antibiotic use both overall and on a per capita gain basis," says Klein.
Antibiotic use more than doubled in India between the year 2000 and 2015. It was up 79 percent in China and 65 percent in Pakistan. Some of that increase was due to population growth but it wasn't just that. Overall sales were up.
So the report makes it clear that the average person in India, China or Pakistan is taking far more antibiotics now than they were a decade and half ago.
Western countries didn't see the sharp rise in antibiotics but they also failed to cut overall consumption.
"In high-income countries reducing inappropriate use has not really ... in most countries ... driven down per capita use rates in the last 15 years," Klein says.
Lance Price, director of the Antibiotic Resistance Action Center at George Washington University, is concerned about this increase in antibiotic use.
"The biggest driver for the evolution of superbugs is the use of antibiotics," Price says. Every time a bacteria is exposed to an antibiotic but isn't killed by it, it has the potential to develop resistance. The evolutionary math is fairly simple. "The more we use antibiotics," he explains, "the more we are going to encourage the growth of these bacteria that are resistant to them."
Hospitals around the world increasingly have been reporting bacterial infections that don't respond to traditional antibiotics.
"Then you have these extreme cases like the woman [in Nevada] just about a year ago who died of an infection that was resistant to 26 different antibiotics," Price says. "So the bacteria are out there that are resistant to everything, and they are becoming more and more prevalent."
Health officials worry about so much growth in antibiotic use in low- and middle-income countries because these drugs are often available there without a prescription. So the potential for misuse is high. Also Price notes that poor sanitation in impoverished nations adds to the problem. If a superbug develops in a patient who only has access to an outhouse, that bug is far more likely to spread into the local water supply than if that patient had access to a toilet connected to a sewage treatment plant.
So the antibiotic fairy is not happy: If we don't change our ways she's going to slowly make the potion less and less powerful until one day it disappears.