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Antibiotic Resistance

On the Brink: Preventing the Next Public Health Crisis

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While antibiotics are one of the greatest achievements in modern medicine, they are only useful if they work.

Carlos del Rio, M.D.

President, Infectious Diseases Society of America

Antimicrobial resistance (AMR) occurs when germs become resistant to the antibiotics created to kill them. This makes infections harder — and sometimes impossible — to treat, resulting in longer hospital stays and even death.

The Centers for Disease Control and Prevention (CDC) estimates that AMR infections cause at least 3 million sicknesses and 35,000 deaths in the United States each year, but the true numbers are likely higher. Before the COVID-19 pandemic, significant progress had been made in the fight against antimicrobial resistance. According to the CDC, between 2012 and 2017, deaths from AMR fell by 18% overall. But the COVID-19 pandemic turned everything upside down. In 2020, AMR infections and deaths rose 15% as a result of the pandemic. That number won’t go back down without efforts targeted at AMR.

The importance of antibiotics

Antibiotics play a critical role in treating individuals with a range of diseases — from patients with cancer who develop an infection during chemotherapy to those with an organ transplant who develop an infection as a result of immunosuppressive therapy. Others can experience an infection as a result of complications of surgery, such
as a hip or knee replacement or a cesarean section.


However, when the infection is due to drug-resistant bacteria, the number of effective antibiotics becomes limited — and so does a doctor’s ability to cure the infection. Data show that 40% of cancer patients admitted to the intensive care unit have drug-resistant infections, and infections are estimated to play a part in about half of cancer deaths. Despite the essential role antibiotics play in modern health care, the development of these drugs has slowed to nearly a halt. There are not enough new antibiotics in the research and development pipeline to meet the threats of many types of bacteria that no longer respond to antibiotics.

Why do bacteria become resistant to antibiotics?

There are many reasons bacteria can develop resistance to antibiotics, but the most important one is inappropriate and indiscriminate use of antibiotics. Nearly 60% of hospitalized patients receive an antibiotic, but more than half of these prescriptions are inappropriate because the patient doesn’t have an infection, or the wrong antibiotic was prescribed.

There are programs that can help doctors in hospitals and other health facilities determine the most effective treatment for infection and ensure antibiotics are only given when there is a clear need, which will help prevent resistance. However, many facilities don’t have these programs in place or don’t have enough staff or resources to adequately meet the standards that have been set. In 2016, CDC estimated that about 1in 3 antibiotic prescriptions in doctors’ offices and clinics are inappropriate.

What can be done

There’s hope with the bipartisan Pioneering Antibiotic Subscriptions to End Upsurging Resistance (PASTEUR) Act—a meaningful legislative solution on the horizon awaiting congressional action. The PASTEUR Act would strengthen our antibiotic pipeline for years to come by changing the way the government funds the development of new antibiotics, as well as supporting effective approaches to appropriate antibiotic prescribing.


Driving research and development of antibiotics is essential to reinforcing the pipeline and ensuring patients and doctors have access to lifesaving treatments that work. Without the proper tools to prevent the spread of drug-resistant bacteria, the country’s already strained healthcare system may face yet another public health crisis.

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