Antibiotics used to treat common childhood ailments are becoming less and less effective, according to a new study. Many of the antibiotics often used to treat infections like pneumonia, sepsis (bloodstream infections), and meningitis, which children often contract, are now less than 50 percent effective, the study published in the journal The Lancet Regional Health—Southeast Asia said.
The worst affected regions by this reduced efficacy are Southeast Asia and the Pacific, including Indonesia and the Philippines. Antibiotics in the United States are also getting less and less effective.
"It is already affecting us in the U.S. This has been deemed a silent pandemic," André O. Hudson, a professor of biochemistry at Rochester Institute of Technology, told Newsweek. Antimicrobial resistance, or AMR, is one of the top ten public health threats, according to the World Health Organization. Illnesses like sepsis kill over 500,000 newborns worldwide every year, with many of these being attributed to antibiotic resistance.
"The WHO, G7, and World Economic Forum have all formally recognized antimicrobial resistance as a global threat to human health. We depend on antibiotics for so much of modern medicine, including all kinds of invasive surgeries (like hip and knee replacements, tumor removal), protecting those who are immunocompromised such as cancer patients or premature babies—the list is long," Lori L. Burrows, a professor of biochemistry and biomedical at the MDG Institute for Infectious Disease Research, McMaster University, told Newsweek.
"Antimicrobials are unique medicines in that they are intended to kill other living things like viruses, bacteria, and fungi that don't want to be killed," Burrows said. "These organisms, like all living things, are constantly evolving through random mutation, and when exposed to antimicrobials, those that are sensitive will die, while those that remain are resistant. Microbes can then trade DNA, so even those never exposed can become resistant courtesy of those exchanges."
The more we use antibiotics, the more pressure we put on the organisms to evolve resistance. The wide use of antimicrobials in agriculture to protect crops and animals, as well as the uncontrolled access to antibiotics in some parts of the world where no prescriptions are needed, has led to widespread resistance. "Certain bacteria can circumvent drugs that are designed to kill them using the natural process of evolution via two primary means: genetic mutation and horizontal gene transfer. A genetic mutation occurs when the DNA of the bacteria changes over time, and if these changes are involved in a gene that is involved in resistance, then the bacteria can evade the drug," Hudson said.
"The changes are then passed on to the next generation of bacteria to perpetuate resistance. In horizontal gene transfer. one bacterium acquires resistance genes from another source, either through their environment (transformation) directly from another bacterium (conjugation) or via bacterial virus (transduction)."
Antibiotic resistance is growing amongst illnesses often experienced by children, scientists have found. The study, which looked into 11 countries across Southeast Asia and the Pacific, reveals that the antibiotic ceftriaxone is now only effective at treating sepsis and meningitis in newborns in one in every three cases. Another antibiotic, gentamicin, was only effective in one in every 2 cases of newborn sepsis.
While this is a major issue in Southeast Asia and the Pacific due to lack of infrastructure for alternative treatments, it is an increasing problem in the U.S. and other countries too. "Approximately 2.8 million people are infected with bacteria deemed resistant to clinically relevant antibiotics, of which 35,000 and 700,000 in the United States and globally, respectively," Hudson said. "In the 2019 report, the World Health Organization states that if no action is taken, drug-resistant diseases could cause 10 million deaths each year by 2050 and that by 2030, antimicrobial resistance could force up to 24 million people into extreme poverty."
When antibiotics cannot treat an infection, it can be serious and often fatal for the infected patient. "If clinically relevant antibiotics are not effective, this can lead to organ failure, death, etc. Sometimes, doctors use last-resort antibiotics," Hudson said. "These drugs are used in very restricted cases as they have severe side effects; for example, the last resort antibiotic, aminoglycosides, can lead to hearing loss and kidney damage."
AMR is especially dangerous for children, as new antibiotics are less likely to be trialed on and made available to children, the authors explain in the paper.
One of the best ways to tackle antibiotic resistance in childhood infections is to prioritize the development of new antibiotic treatments for children and newborns. "Antibiotic clinical focus on adults and too often children and newborns are left out. That means we have very limited options and data for new treatments," Phoebe Williams, an infectious disease specialist from the University's School of Public Health and Sydney Infectious Diseases Institute and co-author of the paper, said in a statement. This requires making funding available for the development of these new drugs "Because companies can charge more for antibiotics in the U.S. than elsewhere in the world, there are more options, but the newer drugs are very expensive," Burrows said. "Most large pharma companies are no longer interested in looking for new antibiotics because they make more money from drugs that people have to take for months or years for chronic conditions versus days or weeks for an infection. This is a big problem when combined with the increase in resistance that we're seeing—we're already being forced to use last resort drugs and there's almost nothing left beyond that."
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