Antibiotics Interview

Dr. HELEN BOUCHER (interviewee): I think people didn’t have any idea the pace at which this (antibiotic production)
would occur. I don’t think very many people understood the risk of overusing antibiotics, which we now understand as
a big reason for the rate of resistance that we’ve seen.

MILES O’BRIEN (interviewer): When did this first emerge as kind of a really important problem? Do you recall when
people started talking about this?

HB: I think for many of us in this business in infectious diseases, we’ve been talking about it for 20 years. But
certainly, most of us would agree with the last 10 years, it’s certainly been at the top of our agenda in the infectious
diseases side of America. And other groups have been working really hard to raise awareness here in America and
others around the world for certainly 10 years now.

MOB: What happened that kind of got people’s attention?

HB: Good question. I think MRSA, methicillin-resistant Staphylococcus aureus, was something that got a lot of
people’s attention. The story of the Saint Louis Rams and other athletes being infected in a serious way from this
pathogen, got people’s attention. The problem of Clostridium difficile causing life-threatening diarrhea also got a lot of
attention.

MOB: So is there a catalogue of resistant bacteria? Do we know how many so-called superbugs are out there?

HB: There is a catalogue. The ones we know about probably number in the hundreds to the thousands. But then
there are the ones we don’t know about. And so one of the many aspects of the response to this crisis is
understanding more and doing surveillance to understand more about what resistant bacteria are here.

We know they come from around the world. We know that when people travel, so do the bugs. And we know that it’s
more complicated even among people. So we know that our food animals carry bacteria and sometimes resistant
bacteria. And we know that bacteria live in the environment, so we’re advocating an approach to make sure we honor
that connection between people, animals, and the environment, and how we both look for the bacteria and treat them.

MOB: Bacteria are something that we need too, so there are good bacteria and bad bacteria, and maybe just neutral
bacteria, depending on where it is. Is that right?

HB: Well, we know there are good bacteria. Bacteria are largely good. And our bodies have orders of magnitude
more bacteria than any other kind of cell. So we wouldn’t be alive without bacteria. Our guts need to have good
bacteria. And we’re learning more and more about this so-called microbiome that is the biology of bacteria in our
bodies. So interrupting that with antibiotics and other things is not so good. And doing it with resistant bacteria is even
less good.

We know that treating a cold with antibiotics and using antibiotics in other ways that are inappropriate speeds
resistance. And that’s an area that we’ve been working hard to address, because that’s something we can control.
We can control not overusing antibiotics.

We’re advocating an approach to make sure we honor that connection between people, animals, and the
environment, and how we both look for the bacteria and treat them.
MOB: How much of this has to do with what happens in the medical world and prescriptions and Z-Paks, etc, and
how much of this is driven by what happens in the agricultural setting? What’s the balance there?
HB: That’s a very good question. And I think we have to say we don’t absolutely know the answer. We’re trying to get
a handle on the answer. We know that using antibiotics for growth promotion in food animals is not a good thing. And
our colleagues in Europe are ahead of us on this, they band it several years ago.

In the US, we just had a new veterinary feed directive from the FDA this year. So, we’re going to see that decrease.
But the magnitude of the problem, we’re still getting our hands around it. That’s been the subject of much discussion
in Washington and in other places.

In people, we know that overuse of antibiotics is a bad thing and we’ve known this for years. And we know that giving
antibiotics for a cold is not a good thing. And giving antibiotics for too long is not a good thing. So, we’ve done a lot to
address that. The CDC and other groups had to educate doctors like, for example, pediatricians to not give antibiotics
for colds and respiratory infections in children. That takes a lot of persuasion, right, persuading moms.