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In the previous installments of Antibiotics: the Broken Promise, we’ve painted a bleak picture for the future of a precious resource. But we can change the course of the future. There’s already legislation in the works. As our Katie Gibas tells us, in order to succeed, every individual must take personal responsibility.

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UNITED STATES -- What will happen with antibiotics is up to us and what course of action we decide to take. But there’s no question that sickness is going to get worse before it gets better.

"It's my father, in his lifetime, that they didn't have antibiotics, so when you're talking about, let's say my grandchildren someday, will they see a time when there aren't good antibiotics for many of their infections. We hope that won't happen, but I think it's a worry. And of course the time to do something about it is now before the cat's completely out of the bag," said Helen Jacoby, St. Joseph’s Infectious Diseases Medical Director.

We’ve already established that it’s going to take discipline from both doctors and patients. But it’s also going to take legislation. The Generating Antibiotic Incentives Now or, GAIN Act, was passed last year. It gives drug companies longer exclusivity periods before generics can come out and a fast track FDA review of the product.

“The actual components in GAIN are probably not going to have the immediate impact that we would like, but they're a great first step and a sign that Congress gets that there's a big problem in this area,” said Dr. Brad Spellberg, Harbour-UCLA Professor of Medicine.

As of right now, GAIN is the only law dealing with antibiotic resistance.
Other legislation has been introduced repeatedly but never voted on.
The Limited Population Antibacterial Drug Approval or LPAD proposal would allow for smaller FDA studies that would speed up getting a drug to market and drastically reduce costs.

Spellberg said, “For directing the development to where the public needs the drugs, you would have much faster studies, much smaller studies and much less expensive studies, so it would serve as a powerful economic incentive.”

The Strategies to Address Antimicrobial Resistance or STAAR Act would create a federal network to monitor antibiotic use.

“There's not a transparent system for reporting and collecting that information, so the people who have tried to get the estimates have had to get at it by various, circuitous routes and whatever you come up with, people will argue over whether it is accurate,” said James Johnson, Infectious Disease Society of America.

“We lack the basic infrastructure in this country to map where resistance is occurring, what kind of bacteria we're having problems with, where those bacteria are located and where antibiotic use is occurring in the United States,” Spellberg said.

Europe already has a similar monitoring system in place called the EARS-net. It tracks all antibiotic use and resistance by country and bacteria.
The legislation here in the U.S. was introduced several years ago, but has not been brought for a vote.

Spellberg said, “I think STAR is perceived to be not necessarily budget-neutral, whereas I think GAIN is perceived to be budget neutral. And right now, I think the thought is, if we have to invest in building this infrastructure of surveillance network sites, that’s something that's not attractive if it's not budget neutral.”

But health professionals and scientists say legislators must start taking action before it’s too late.

“Let's say we turned around antibiotic discovery tomorrow, it's still 10 years before you discover a new drug and it hits the market. So you're looking at a decade lead-time minimum, assuming we turn things around tomorrow. We're making slow, at best, incremental progress in terms of infection prevention and antibiotic stewardship, protecting out antibiotics,” Spellberg said.

And to do that, we need to start thinking of antibiotics as precious limited resources.

Spellberg said, “When you use an antibiotic, it affects how the antibiotics are going to work in me. And that's not true of any other drug. The spread of resistance affects all of us. So these are a shared, collective public resource, and we have not been treating them like that. And that's how we need to begin to think of them.”

Experts say once we’re able to change attitudes, they’re positive the political action will follow.

Overuse of prescription drugs has led to a crisis as bacteria has fought back, developing a resistance to the very medicines designed to kill it. You may think you've done your part by avoiding unnecessary prescriptions. But as Katie Gibas tells us in this segment of Antibiotics: Broken Promise, you may be getting a regular dose of antibiotics and resistant bacteria at your dinner table.

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It’s a long way from the pharmacy to the farm, but that’s where an estimated 80 percent of antibiotics are used. Almost since their invention, antibiotics have been prescribed for sick animals.

"Animals that don't get sick perform better," said Mike Baker, a Beef Cattle Extension Specialist.

Beef Cattle Specialist Mike Baker says the benefits of antibiotics go past just treating illness. They also improve animal production. There are certain antibiotics in the farming industry that aren’t used in humans at all.

"Better digestion. We can have a higher level of production with less amount of feed. Less amount of feed means less amount of land that has to go into animal production and so on," said Baker.

But there has been a history of giving antibiotics to animals that aren’t sick. Especially at larger operations out West, animals are often fed a low dose of antibiotics on a daily basis.
And many argue it’s doing more harm than good.

"When you're giving low levels of antibiotics, not enough to kill the bacteria, what you're doing is really setting up the perfect way for bacteria to become resistant to the antibiotics that are being given to the animals,“ said Gale Hansen, a public health veterinarian.

A prime example of the growing resistance is food products that are recalled every year.

"There was 36 million pounds of ground turkey that was recalled last year because of a bacteria called Salmonella Heidelberg, and that bacteria was resistant to several antibiotics. Those are the same antibiotics that are fed to the animals and made it much more difficult to treat the people who needed to be treated. We ended up with one person dead and over 130 people sick,” said Hansen.

The growing resistance is one reason many farmers have converted their operations to antibiotic free or organic. Kathie Arnold’s dairy farm went organic in 1996. That means the cows cannot be treated with antibiotics, hormones or many conventional medications.

"We have not missed them anywhere near as much as I thought. Number one, there are a lot of plant-based, herbal medicines and vitamins and so on that we can use," said Kathie Arnold, the owner of Twin Oaks Dairy LLC. "We are required if an animal needs to have antibiotics to save their life, then we have to treat them. But then that animal is no longer organic, and so she'd have to be removed from the farm."

Roy Smith farms chickens for egg production. He only uses antibiotics on sick animals.

"We vaccinate to build up immunities, so when they get in the laying cycle, they won't get these diseases," said Roy Smith, a Smith Quality Eggs LLC Partner.

Both Arnold and Smith say they've learned to manage their animals so they don’t get sick

"We keep all animals away from the birds. We keep everything tight. We don't allow people in with the birds or anything like that so that there's no chance of tracking in diseases and such," said Smith.

The Preservation of Antibiotics for Medical Treatment Act, or PAMPTA, would ban the use of antibiotics for growth promotion in animals. It has been proposed several times but never voted on.

While little progress has been made here in the U.S., the European Union has already outlawed the use of antibiotics for animal growth. Sweden and Denmark were the first two countries to adopt the policy and their findings show an over reduction in antibiotic use, a drop in resistant bacteria and no worsening of animal health.

“Overall, there was no decrease in production and the Danish meat production industry has remained hugely economically viable. They're work leaders for exporting pork for example and Switzerland similarly so in their poultry industry,” said James Johnson, of the Antibiotic Working Group of the Infectious Disease Society of America.

But until legislation in the U.S. catches up, experts say we as consumers can take the matter into our hands by putting our money where our mouth is.

"If consumers were to shift away from buying conventionally grown products and prefer so-called antibiotic free or organic, then it would become apparent to the producers that that's the way they need to go just to meet the customer demand,“ said Johnson.

But experts believe it will take legislation and time, to bring about a big enough change to reduce the resistant bacteria bred by animals.

As infections become more and more difficult to treat and the public health threat looms, doctors’ offices and hospitals must change the way they do business. In this segment of Antibiotics: The Broken Promise, our Katie Gibas tells us about practices that have led to a rapid increase in resistance and what health care professionals must do to address the issue and educate their patients.

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"Everybody has the same common hope, do the best you can for my child but do the least discomfort," said Dr. Frederick Roberts, a retired pediatrician.

And too, often parents think the “best” involves a prescription.

"If you're a working parent and you take your child out of school, and you drive a half hour to the appointment, then you sit in the doctor’s office, then you find the doctor and all the doctors says is, 'No, you have a cold,' and then you have to drive the half hour back and then get your kid back in school, and then finally, you get back to the office, and you've just used three or four hours of your morning, only to have the doctor say, 'No, you only have a cold,' well, that's the way it should be done. But there's an enormous amount of pressure to be able to treat something. Parents want something to give to their kid," said Dr. Mark Polheums, an Upstate University Hospital Infectious Disease Specialist.

Dr. Waleed Javaid, the Upstate University Hospital Infection Control Dir., and Chair of the Antibiotics Subcommittee, "It's very easy to write an antibiotic. You scribble a pen. You write an antibiotic and you're done. It's very hard to sit down with a patient, hold their hand, and tell them 'This is what's happening. Let's hold off on the antibiotic for this many days. Let's see if it gets better. And then go on from there.'"

For parents in search of quick cures, it may take years of consistent messages from care-givers to change attitudes.

"I think it's a matter of discipline. The doctor has to be disciplined. And the patient has to either accept the doctor's best interests, best information, or to walk with their feet and go elsewhere," said Dr. Frederick Roberts.

Dr. Helen Jacoby, the St. Joseph’s Infectious Disease Medical Director added, "It's important to note that if it's really just a cold, the antibiotic really won't make a difference. People will say, 'Well, I got an antibiotic last time, and I felt better in a week or two,' but that's probably just the natural history of the cold because you're sick for a few days before you go to see the doctor. Probably that was about the worst it was going to be anyway. You go home and you start to feel better."

Dr. John Epling, the Upstate Family Medicine Chair said, “I can tell you until I am blue in the face. I can tell people what the issues are, but I need to also understand their concerns. I think that’s the biggest issue. We need to be in this together as a society.”

Hospitals are Ground Zero in the battle against resistant germs. It’s estimated that more than 100,000 U.S. hospital patients die every year from these resistant bugs.

Hospitals have already done the obvious to reduce infections by cleaning every patient room with bleach and implementing programs as simple as washing your hands, which St. Joe’s says has already resulted in a huge drop in infections.

But the epidemic also has hospitals looking at how their own policies can affect resistance.
Jacoby says studies have shown that 50 percent of antibiotics prescribed in a hospital aren’t necessary. That’s why hospitals are implementing antibiotic stewardship programs.

"We now have pharmacists who are now reviewing those charts, checking to see if those antibiotics seem to be appropriate, reviewing difficult cases with one of the infectious disease doctors and then going to the person's physician with the evaluation and saying, 'Hey, do you still need this antibiotic at this point or might you consider narrowing down the antibiotics,'" said Jacoby.

Most hospitals have antibiotic stewardship programs, but the doctors we spoke with say they’re concerned about the lack of oversight and initiative by private primary care offices to try to tackle the over-prescription of antibiotics. They say sweeping legislative action might be the only solution to get widespread compliance.

As antibiotic resistance continues to increase, the options to treat diseases become more limited. In 1990, there were 20 major pharmaceutical companies with large antibiotic Research and Development programs. Today, there are just two and a handful of smaller ones. In this segment of Antibiotics: The Broken Promise, our Katie Gibas tells us why Antibiotic development has dwindled to almost a standstill in recent years and what that means for the future of medicine.

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After the introduction of antibiotics in the 1940s, companies ramped up production of these infection fighting drugs.

“We were always sort of one step ahead and when they could catch up with resistance, we would come out with the next thing. And that’s the part of the equation that’s changed,” said Dr. Brad Spellberg, a Professor of Medicine at Harbour-UCLA.

Fewer and fewer new antibiotics are hitting the market. According to the Infectious Disease Society of America, 16 new antibiotics were approved between 1983 and 1987. Only two have hit the market since 2008.

"It's an enormous investment to make a drug, both time and money. And the hurdles are many. First to find the compound that is a novel compound that is something that is unique and makes your drug special and therefore, marketable, that's tough. And then to put it through all the human use testing that has to go on, the post market testing, you're talking about drug development in decades and in hundreds of millions of dollars," said Dr. Mark Polhemus, an infectious disease specialist at Upstate University Hospital.

And with that kind of capital project, drug companies want to maximize their return on investment.

"If you can get a medicine that lowers your cholesterol and have a person take it every day for 40 or 50 years, or a heart medicine, that's a much better return on your investment than trying to get someone to be one of a number of options and then taken only for 10 days," said Polhemus.

All the while, resistance just keeps increasing.

"If a person is sick from one of these resistant drugs, and you're already down to the second line therapy, some of them, we don't have third line and fourth line therapies that we can move to. So if we fail those second line therapies, we're in trouble," said Polhemus.

Plus, fewer options means more of a commitment from patients.

"Those options are incredibly expensive. We don't necessarily have the oral options, the pill options. Some of those are just in IV," said Polhemus.

Dr. John Epling, the Chair of Family Medicine at Upstate University Hospital added, “We don’t want to get to a point where we have to treat people intravenously right out of the gate for something that would otherwise be treated orally.”

Resistance is becoming a major concern for the future of medicine.

"It’s already too late. Many, many patients have already died of infections that are resistant to everything. And of course, tens of thousands die of resistant infections we may only have one of two drugs left to treat. It’s not like we’re going to be ahead of the game if we solve this issue. We’re already behind. The microbes are already ahead," said Spellberg.

Dr. Helen Jacoby, the Medical Director of Infectious Disease at St. Joseph's Hospital added, "Pretty much every bacteria we have is becoming more resistant to antibiotics. Resistance is developing faster than new antibiotics are being developed. And the antibiotic era isn't even 100 years old yet. So the question is, over the very long-term what will happen?"

Experts say it’s going to take a huge culture shift and reinvestment in antibiotic research and development to turn things around. Something they say needs to happen now, before it’s too late.

It didn't take long for doctors in the 1940s and 1950s to realize that while the new "wonder drug," penicillin, had given them a powerful weapon in the battle against bacteria, there would be no surrender by organisms that had survived since the dawn of time. In this segment of "Antibiotics: The Broken Promise," our Katie Gibas says the survivors of the first assault on infection have comeback as so-called "superbugs" posing greater threats than their ancestors had in the pre-penicillin days.We do want to warn you that some of the video you're about to see may be too graphic for some viewers.

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In the years following penicillin, a number of other antibiotics were developed, including methicillin, vancomycin, tetracycline, and erythromycin. But eventually bacteria became resistant to those too.

"Infections become harder to treat because there's no one drug you can go to which is going to be completely reliable for any particular condition," said Dr. Helen Jacoby, the St. Joseph’s Hospital Infectious Disease Medical Director.

It was a simple case of "too much of a good thing." Doctors and patients misused and overused the antibiotics and resistance dramatically increased.

"People who will see their doctor for a cold, which is usually do to a virus or bronchitis which is also usually due to a virus, and will want an antibiotic or the doctor will feel bad that there's nothing to advise other than time and rest and fluids, and then will them prescribe an antibiotic in a way to feel as if they're doing something," said Jacoby.

Some of the major causes of bacterial infections in the US are E. coli, Salmonella, Enterococcus and Staphylococcus. They’re all becoming increasingly resistant to antibiotics.

"We had a friend, she was just in her early to mid-60s who died a couple months ago because she got an ecoli infection, and the antibiotics were not effective," said Kathie Arnold, an Organic Dairy Farmer.

Jacoby added, “E. coli is the most common cause of bladder infections, but now, there's a lot more resistance of E. coli to various antibiotics. So there isn't one antibiotic that I can tell you with 90 percent certainty that it will kill your bladder infection."

One of the most common "superbugs" is Methicillin Resistant Staphorrius, more commonly referred to as MRSA.

"It’s very scary because for one, you realize that they’re not even sure how to handle it because these cases are changing and evolving. And what they did with MRSA a year ago, might not be what they have to do currently. And just the fear of losing a limb and the mortality of it, said Jonathan Capra, a former MRSA patient.

Valerie McDowell, another former MRSA patient added, "One of my friends had a tattoo and ended up with MRSA on the tattoo, which ended up metastasizing to the brain, and he ended up with an abscess in the brain. They had to go in and do brain surgery to take the abscess out. Then he was on an IV antibiotic for a long period of time."

Valerie McDowell has had MRSA twice, and she’s allergic to one of the antibiotics that works against the infection.

"I don't know if I'm going to be more susceptible in the future. I've already had two bouts of it. Luckily they've just been skin infections and they've cleared with treatment. But the last treatment was a 28 day course of antibiotics. And he had to open up the abscess and drain it," said McDowell.

Laura Gray works in infection control at St. Joseph's hospital in Syracuse. Several years ago she fell victim to one of the very bugs she combats each day.

"At first, I was scared because I didn't know. I didn't have a lot of information about MRSA itself. And even being a nurse, you heard the term MRSA and you thought, 'Oh, my. This person has got a huge infection. Got to stay away from them,'" said Gary. "I guess you'll never really know why it happened. Have I had cultures since? I have and nothing has ever come back positive. Was it a one-time thing? Maybe. Will it ever come back again? Maybe."

The years have also shown that resistance is not the only challenge in a world demanding use of more and more antibiotics.

"The patient might have an allergic reaction to the antibiotic. And then there are other infections that are associated with antibiotic use. There's something called C. Difficile diarrhea, which is an infection that can develop in the bowel when people have been on antibiotics and causes a horrible diarrhea and requires another antibiotic to treat that," said Jacoby. “We have had people have to high bowel surgery for C. Diff and again, we've had people die from it.”

And one of the biggest challenges with C. Diff is that it’s difficult to kill. The patient must be treated with high doses and often long courses of antibiotics. But keeping the hospital clean is even harder because the C. Diff spores can only be killed with bleach or high doses of ultraviolet light for long periods.

"All of these organisms have been around a lot longer than we have. So anything we come up with to get rid of them, they're still a step ahead of us," said Laura Gray, a Registered Nurse at St. Joseph's Hospital.

That means, the key to treating these bugs is prevention. The easiest prevention method is washing your hands with soap and warm water for 20 seconds. So just how long is that? Sing ‘Happy Birthday’ twice and you’re covered.

"I don't want anybody to live in a bubble but it's good to have some sort of fear. Your best defense is to wash your hands. People laugh at me. People think I'm kidding when I say that. They call me a germ-freak. But it's a very simple thing," said Gray.

But prevention alone isn’t enough. Resistance will just continue unless new antibiotics that work in completely different ways are developed to outsmart the bugs.

It was the closest thing to a miracle that the medical community had seen in centuries. Lingering in mold in a laboratory, a substance that promised cures for a host of illnesses that had ravaged the population. In her series, "Antibiotics: The Broken Promise," our Katie Gibas says the "wonder drug" changed the landscape of medicine for the 20th Century, but also set the stage for medicine's most serious challenge in the 21st.

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SYRACUSE, N.Y. -- Retired Pediatrician Dr. Frederick Roberts said, "Medicine was wonderful. It was the best there was in the world. We were on top of everything. No one knew more than we did in the United State of America. We thought. How wrong we were. How things changed both for the better and for the worse."

Dr. Roberts has seen a lot in his more than six decades as a pediatrician. He remembers life as a child before antibiotics.

"We had illnesses that were so terrible and so devastating, children and adults were dying of the pneumonias, the mastoid diseases, the meningitis, all the things that ravaged human beings," he said.

Scientists had been searching for an answer to cure patients for centuries. In the late 1800s, the research really took off. But it wasn’t until the 1940s that there was any sort of relief. The days before antibiotics were often just trial and error medicine with home and natural remedies.

"There wasn't much you could do," Dr. Roberts said. "That's why the major things that were done in the past are things that we look at with contempt now. They used to bleed the patient. George Washington died, I'm sure, from efforts of his doctor rather than from the illness he had."

Dr. Helen Jacoby, St. Joe's Infectious Disease Medical Director, said, "They would inject the bacteria into animals, a horse for instance. The horse would then make antibodies to the infection. They would then take antibodies from the horse and inject these into people."

Dr. Mark Polhemus, Upstate Infectious Disease Specialist, said, "For abscesses, you had to drain them, for teeth, you had to pull them. For fingers, hands, legs, that were infected, you had to cut them off."

In 1928, Sir Alexander Fleming accidentally discovered Penicillin when he found mold growing on his culture plates after returning to his lab from a month-long vacation. But it wasn’t until more than a decade later in 1943 that the drug was able to be mass-produced for patient use.

Dr. Roberts retired as Central New York’s longest serving pediatrician last summer, at age 92. When he began his practice in 1946, antibiotics were just starting to be used widespread.

He said, "They thought you could clean out the whole closet of germs. All you had to do was take a squirt of this magic drug and zippo! You were in business forever."

And for a while, antibiotics did seem to heal all.

Dr. Roberts said, "That was a major, major breakthrough, and suddenly we had some really potent medications that treated numerous conditions."

Dr. Polhemus said, "I don't think anybody really knew anything about antibiotics. They knew that they helped infections, but initially nobody knew the breadth of what it was, so antibiotics were used for everything that could be considered an infection."

After just four years, Penicillin seemed to be losing its effectiveness.

Dr. Roberts said, "The bugs got smart and they developed resistance. And the doses that we gave originally were trivial."

Dr. Polhemus said, "Organisms since the dawn of time have been trying to figure out a way to outlast the immune system or whatever is killing them. The same thing happened with antibiotics."

Dr. Brad Spellberg, UCLA Professor of Medicine, said, “In 1945, Alexander Fleming who discovered Penicillin gave an interview to the New York Times in which he warned that physicians were wasting Penicillin and if we didn’t stop over-using it, we were going to lose it to resistance. That was 70 years ago."

Within a few years, that prophecy was fulfilled as Penicillin stopped working all together to treat Staph infections.

Dr. Jacoby said, "Bacteria multiply very, very rapidly and there's always a certain rate of mutant bacteria that develop. And it's only a matter of time before some mutant bacteria that are resistant to that antibiotic develop and they're the only ones that aren't killed by the antibiotic. So gradually, over time, the more those bacteria see the antibiotic, the more any mutated bacteria can grow and eventually, that's the only version of that bacterium that you see."

Despite resistance, dozens of pharmaceutical companies continued to produce antibiotics that were able to keep the bugs in check. But around the 1980s, their focus shifted to more lucrative options. Resistance continued to grow.