For those with cash to spare, there are doctors.
For those without, there is Cipro.
The drug, a potent antibiotic, has a worldwide reputation for wiping out bacterial infections with a vengeance. “That’s the one customers usually ask for,” says Cherry, 32, who runs a Bangkok pharmacy on a noisy urban strip lined with massage joints and 7-Elevens.
If a customer has diarrhea? “I give them Cipro,” she says. Gonorrhea? “Usually Cipro.” Pneumonia? “I think we have something even stronger than Cipro,” Cherry says. “But they’d better see a doctor.”
This is the way much of humanity seeks medical treatment — in an open-air pharmacy doling out $2 to $5 packets of pills.
No prescription necessary. And hardly any medical science, either.
Cherry wears a white lab coat to work. But she isn’t a doctor. Still, she does her best to guide customers toward the best antibiotics for their ailments. “Most,” she says, “just want to buy the strongest pill we have,” regardless of whether it’s known to be effective against what afflicts them.
This free flow of powerful antibiotics is breeding a devastating consequence: “superbugs” that have evolved, in Darwinian fashion, to fight and win against antibiotic treatment. As the Centers for Disease Control explains: “When bacteria are exposed to antibiotics, they start learning how to outsmart the drugs.”
So the more they are used — and the more they are misused, for the wrong ailments or without completing an entire course — the less effective they become.
Humanity is fast approaching a “post-antibiotic era,” according to the World Health Organization. If unchecked, superbugs could reset the clock to a time when pneumonia, dog bites and urinary tract infections were life-threatening afflictions, even in the healthiest countries.
“This is no longer a prediction for the future,” says a new WHO report backed by data from more than 100 countries. “It is happening right now in every region of the world and has the potential to affect anyone, of any age, in any country.”
Ranking among mankind’s greatest discoveries, antibiotics have gained a popular reputation as a miracle cure-all.
In much of the developing world, buying antibiotics is hardly more difficult than buying a Pepsi.
In the US, where buying antibiotics requires a doctor’s prescription, “the public often expects or demands antibiotics for every sniffle that comes along,” according to the California Medical Association. In China, a Peking University study shows the meds are prescribed “twice as frequently” as the WHO recommends. In India, common antibiotics were legally sold with no prescription until this year.
The upshot? If unchecked, superbugs will become far more threatening than AIDS. This isn’t some dire prophecy. HIV and AIDS contributed to the deaths of roughly 15,000 Americans in 2010. A superbug called MRSA — a potent strain of staph bacteria — kills at least 11,000 Americans per year and, according to the Pew Health Group, fewer and fewer antibiotics are proving capable of treating it.
Unlike HIV, superbugs aren’t easily preventable. One of the biggest risk factors is simply being admitted to a hospital, where the bugs camp out. Antibiotic-resistant bacteria can infect anyone who nicks their finger while chopping onions. Or walks barefoot through a public shower. Or simply falls ill from the flu, which can weaken the immune system and allow an infection to proliferate. In the world’s most destitute places, where antibiotics are still scarce, these are modern-day threats.
Surgeries, from hip replacements to organ transplants, leave patients particularly susceptible to superbug infection. Diarrhea, gonorrhea and pneumonia are flagged by the WHO as “high concern” ailments potentially caused by superbugs.
The world must now mobilize against superbugs “as it did to the AIDS crisis of the 1980s,” says Laura Piddock, a University of Birmingham microbiologist.
But as of now, new classes of antibiotics able to take down superbugs aren’t in the pipeline. “Very few new antibiotics are being developed by pharmaceutical companies,” Piddock says, “and some have even stopped developing these drugs altogether.” A completely new class of antibiotic drugs hasn’t been discovered since the 1980s.
Governments around the world are just now waking up to the superbug threat. Both China and India have warned doctors to stop overprescribing antibiotics.
But as in much of the world, the US included, antibiotics are already fixed in the public’s mind as a wonder cure and are often demanded from doctors.
Often, physicians acquiesce: 65 percent of US pediatricians offer antibiotics when “they perceive parents expect them,” according to the California Medical Association. But if parents don’t bring up antibiotics, they’re prescribed only 12 percent of the time.
The association also complains that American doctors commonly hand out antibiotics for colds and flus, both caused by viruses antibiotics can’t even fight. (Antibiotics don’t attack viruses, only bacteria.)
This bodes badly for the world’s poor, who are more likely to fall ill and less likely to access a skilled doctor. Their health care is more often meted out in drug stores that don’t ask questions. India has already “lost” the superbug war, according to the microbiologist who led research into one of the nation’s most dangerous superbugs; his revelation, he claims, got him kicked out of the country.
This bleak superbug forecast is reinforced by Doctors Without Borders, which sends clinicians to the world’s poorest and most remote places. In response to the WHO’s report, the agency says it already sees “horrendous rates of antibiotic resistance wherever we look in our field operations” and urges a global “wake-up call.”