National Geographic News
Microscopic image of the bacteria that causes gonorrhea.

Many bacterial infections, such as gonorrhea (microscopic image above), are no longer easily treated with antibiotics.

PHOTOGRAPH BY SCIENCE PICTURE CO., CORBIS

Susan Brink

for National Geographic

Published May 1, 2014

The spread of superbugs—bacteria that have changed in ways that render antibiotics ineffective against them—is a serious and growing threat around the world, according to the World Health Organization's first global report on antibiotic resistance.

Once-common treatments for everyday intestinal and urinary tract infections, for pneumonia, for infections in newborns, and for diseases like gonorrhea are no longer working in many people.

The new report on the global threat adds to a Centers for Disease Control and Prevention report last year showing that two million people in the United States are infected annually with antibiotic-resistant bacteria, and 23,000 of them die each year as a result.

To understand the dangers posed by superbugs, National Geographic spoke with Stuart Levy, chair of the board of the Alliance for the Prudent Use of Antibiotics at Tufts University School of Medicine in Boston.

What exactly are superbugs?

They are bacteria resistant to one or more antibiotics, and they make it difficult to treat or cure infections that once were easily treated. The antibiotic has lost its ability to control or kill bacterial growth. The bacteria can grow even in a sea of antibiotics because the antibiotic doesn't touch them.

How are the bacteria able to circumvent the power of antibiotics?

The bacteria have acquired the ability to destroy the antibiotic in order to protect themselves. They've developed a gene for resistance to, say, penicillin, and that gene protects them. A genetic mutation might enable a bacteria to produce enzymes that inactivate antibiotics. Or [a mutation] might eliminate the target that the antibiotic is supposed to attack.

A bacteria may have developed resistance to five or six antibiotics, so in treatment, you don't know which one to choose. And the bacteria accumulate resistance by developing new genes. Genetics is working against us, almost like a science-fiction story.

Why are these superbugs spreading and the threat growing?

We're continuing to use antibiotics in a bad way. They're supposed to be used to combat bacteria, not viruses. The common cold is a virus. Any time you use an antibiotic when it's not needed, you're pushing antibiotic resistance ahead. People are misusing them in their homes. They may have a stockpile they've saved, and think taking [an antibiotic] will help them with a cold. They're not helping their cold, and they're propagating resistance.

What about other uses, such as using antibiotics in animal feed by the meat industry?

This is a big issue. About 80 percent of antibiotics manufactured are given to beef cattle, chickens, and hogs to help them grow better and put on more weight. They excrete them, and the antibiotics largely are not broken down. They enter the environment—the ground and the water—and retain their ability to affect bacteria and promote antibiotic resistance.

The Food and Drug Administration has come out with a voluntary plan for industry to phase out antibiotic use. I've been championing this for 30 years.

How can we combat the further growth and spread of superbugs?

By using antibiotics only when we need them. And by eliminating their use in animals. There's a paucity of new antibiotics to take care of these multiresistant superbugs, so we're at the mercy of the bacteria.

Are there new antibiotics in development?

The journal Microbe did a report this month on wakening to the need for new antibiotics. There are a number of new antibiotics being studied. They're not there yet, but at least they're in the pipeline.

This interview has been edited and condensed.

72 comments
ashutosh awasthi
ashutosh awasthi

introduction of a new generation of antibiotics is not a solution to this problem.although it will give us some extra time to do more research on antibiotics as well as the behavior of this new generation of bacteria. but the point which we are missing here is that the rate of evolution of these bacterias is quite higher n faster too. so it will be much better for us to minimize the use of these medicines and again switch to old ways of curing common problems.


Jon Smith
Jon Smith

What this article does not cover unfortunately is the growing scientific awareness of the impact of antibiotics on the human and animal microbiome - our internal environment of commensal, symbiotic, and pathogenic microorganisms that completely shares our body space, are essential to our gut efficiency and are at the centre of our immune system. The impact of antibiotics on this internal environment is devastating and links are rapidly being made between our overuse of antibiotics and the epidemic of chronic diseases such as cancer and diabetes. 23000 deaths a year from superbugs is just a small and obvious part of the story. Much more insidious and pervasive is the wider story of chronic disease that massive overuse of antibiotics is contributing too .

Meichen Qian
Meichen Qian

强大的人类竟战胜不了小小的病菌!太可怕了!大自然无法征服!

Erin Scott
Erin Scott

Try to fight off anything as long as you can, still using your head of course. Then go to the doctor chances are it will clear up before you know it..

Athanasia Vardakis
Athanasia Vardakis

This is an extremely serious issue, almost all my peers take antibiotics totally unnecessarily. Not only is this worsening the case for them but for everyone else also!

Sheryl Kay
Sheryl Kay

It's so hard to keep yourself healthy and strong, but this scares me...

Johanna Kristiansen
Johanna Kristiansen

wonder if cancer is a superbug, because I think that it's hard to cure and a lot of people die of it.

kristijan nikolov
kristijan nikolov

Before couple weeks i had stuedied the effects of antibiotics(betalakmythas) and their negative sites and other stuffs about resistence MRSA  types in microbiology . Its really interesting theme for descussion  id like to know who are the new antibiotics on wich scientist work as we read it in the last paragraph about the new  antibiotics :).


kristijan nikolov
kristijan nikolov

пред скоро време ја научив студијата во врска со лекови против бактерии и (беталакмитази) како и  нивната резистентнос многу интересна тема и би сакал да добијам одогвор доколу може да знам кој се новите антибиотици на кој што работат научниците и на кој начин тие би делувале 

An Thrope
An Thrope

Looks like the ending to "War Of The Worlds" might apply to us too if we aren't careful.

Vimanga Randeniye
Vimanga Randeniye

Bacteriophages are a type of viruses that use bacteria to inject their genetic material into other host cells. So they use bacteria as a kind of vector. At least from what I know. 
But yes, mostly this resistance to antibiotics is due to over-prescription of antibiotics. 
The bacteria develop resistance to antibiotics due to frequent and repeated use of antibiotics. It's this that led to the rise of MRSA (methicillin resistant Staphylococcus Aureus) which is a main hospital infection. 

Unfortunately, doctors in checking for resistances have to use antibiotics which means that the process of checking of resistance can actually contribute to more resistant bacteria as well.


It's a fast growing problem and holding back on antibiotic prescription won't solve it either. Antibiotics still save millions of lives everywhere.

Hannah George
Hannah George

I am 81 and lived my whole life on common sense prevention and cure  learnt from my simple  native culture in the tropics with home made healthy meals. personal cleanliness, home and environmental cleanliness was important....it is hard work, not fun! We washed our hands often. Life in the West is so different and contrary to what I was used to; but I still try my best to not go with the flow.  We have lived a simple and a healthy life without having to consult doctors, but very strangely last October  for the first time I had to consult a doctor, because what i thought was an ordinary flu turned out to be an infection of the lungs and was diagnosed with pneumonia and for the very first time in my whole life I was on antibiotics for a short period of time. It has slowed me down and life has changed drastically and I am still recovering from it! The 2013 winter wasn't very co operative either! I usually enjoyed my long winter walks which I am deprived of!.. but I now spend more time on my computer reading, learning and enjoying the changing world that I live in without changing my healthy habits..  I still am able to do my own cooking and cleaning.

Alioscia Papout'
Alioscia Papout'

Intereresting article, why is there no reference to good diagnostics : testing the bacterias resistances before prescripting antibiotics. And most of all please make an article explaining what are bacteriphages : http://en.wikipedia.org/wiki/Bacteriophage this might be the future of antibacterial treatments.

Ian James
Ian James

After visiting an infected grandchild, my wife, who is approaching 70,  just got over the nastiest bug I've every seen (3 weeks of constant coughing/sinuses/fever ).  I needed to look after her and  couldn't afford to get it as well so I paid particular attention to washing my hands and keeping her out of the kitchen.  it worked.  washing hands goes a long way... and it's not that hard to make part of your daily routine.  

Eric Tucker
Eric Tucker

Can we also put an end to anti-bacterial hand sanitizers and soaps. The excessive use of these products in hospitals, where the super-virus, MRSA, first appeared, seems to be a very strong indicator that over use of these products do not create a sterile environment as much as they lead to superbugs in those supposedly sterile environments.


Cecilia Mitton
Cecilia Mitton

My Mother taught us this as children, she'd tell us to wait 3 days before a Doctor's visit...usually we didn't have to go as it was usually a virus,like a cold. I'm 51 now and still listen to her words of wisdom.

I have had some pretty rough colds and flus, but have not ever taken antibiotics ...I also only seem to have the cold/flu for less time, perhaps by NOT taking the antibiotics I've built a pretty healthy immune system?

Natalie R.
Natalie R.

I like this post, it breaks it down into simple to understand language and recommend the read. It is important for everyone to understand that running to the doctor to get antibiotics for the common colds that we all get is not helping. My mother keeps doing the same, every time I get a cold or the kids or my husband gets a cold she'll say 'Go to the doctor!' No matter how many times I try to explain to her that the common cold is a virus and that antibiotics don't help and are likely doing a great deal worse than good!

Carlos Prado Kittel
Carlos Prado Kittel

measles and mumps are viral infections, so ATB don´t have any influence on their come back.

The reason for them to come back is the unfounded fear some groups have of vaccination because of rummors that claim they cause autism or other conditions.

Cindy Tiller
Cindy Tiller

I and many others who use alternative remedies knew super bugs were coming years ago,we said so. Ask yourself what organizations kept pushing these antibiotics. Pharma companies did and they knew what was coming soon. Pose the question when did  big Pharma start developing  Steroids such as prednizone? It is one of the most common drugs being prescribed now. Now pose the question What long term negative effects it has?How long has pharma known and why do we the people allow it?

Eboy Tan-Torres
Eboy Tan-Torres

Just let our immune system work rather than getting flu shots & prescribing antibiotics to cure all sickness.   

Cindy Harris
Cindy Harris

It's not just people misusing them, doctors prescribing antibiotics to patients before they even know what they are treating.  See this all the time in the nursing home, patients being treated for something they haven't even been tested for yet.

Uzair Khan
Uzair Khan

Can you plz make me understand how extra use of antbiotics make bacteria resistance to them...how they get mutated why dont they get kill by antibiotics when encounter with them.............?????? 

Jack Vigil
Jack Vigil

@Erin Scott Unfortunately that might not work out for newborns if their medication isn't working. :(

Monica Luu
Monica Luu

@Johanna Kristiansen  Cancer isn't a superbug, it is the result of cell mutation, not bacteria.  Superbugs are to do with antibiotic-resistant bacteria.

Hector P.
Hector P.

Sigh... Congratulations, you've outsmarted some very smart people. I do hope you understand that antibiotic-resistant bacteria was an inevitability. If it wasn't now it'd be 20 years from now and we'd also have people like you saying, "if only we'd payed attention!!". You remind me of a woman who lived near my grandmother who refused to have her MANY children vaccinated. Government workers would go directly to peoples' homes to offer vaccines to young children and every time she said no. She wanted her kids to not fall prey to "big pharma". Of her 12 kids, 7 died of illness before they reached 10 years old. Some before 5. Such ignorance ends lives, not saves them. Everything comes with risk. Hundreds of years ago people were lucky to reach 50. Now in part to those "dastardly" big pharmaceutical companies people can live twice as long. The point of this article has gone over your head. Pharma makes the meds, but doesn't prescribe them.

Cecilia Mitton
Cecilia Mitton

@Cindy Tiller  I agree with you Cindy...Pharma Companies aren't into saving anyone or helping the public at large-I think we all know what they really are into---MONEY! Sad really, such a big beautiful Planet we have,and yet children die in the thousands everyday because they can't afford the 3 cents it takes to get a measles shot---for shame!

K O
K O

@Eboy Tan-Torres  You have a point on the antibiotics for sure, as demonstrated by research and called out by health experts all over the world. 

But the immune system as substitute for flu shots?  Yes, those thousands of mostly elderly people who die of the flu every year should just let their "immune system work." How about all those millions who died in the Flu Pandemics in the early 1900s? Tell us how well their immune systems worked for them.  Flu is not always some benign disease we should let go through us. It mutates. And even when it doesn't, it kills the vulnerable. Vaccination is about protecting the vulnerable in society by keeping viruses from going through the herd. I vaccinate not to protect myself, but my disabled parents or someone's grandmother or great grand-father.


btw: Flu is caused by a virus, not bacteria, which is what this article is about.

Timothy Chase
Timothy Chase

@Uzair Khan  A given strain of bacteria may not be as susceptible to specific antibiotic as others, and you may not need to use the antibiotic against that strain anyway.  But by introducing the antibiotics, since it kills some bacteria from that strain it will select for those mutations that make the bacteria even less susceptible.

Alternatively, the first few mutations that render a given strain of bacteria immune to a specific antibiotic may result in a fitness hit, such as a decreased ability to digest certain nutrients or increased replication time.  Reducing their exposure to the antibiotic means that the strains that do not have that mutation will have an advantage over them and they are more likely to be selected out. However, if you use the antibiotic you may given them more time for other mutations to occur such that some will have the same ability to digest the nutrients or replicate as before, and they will be more likely to remain within the population, preserving the resistance gene.

Similarly, as Lim points out below, not continuing with your treatment for the prescribed amount of time or as frequently as you are supposed to may provide bacteria with additional time in which to evolve mutations that render them less susceptible to the antibiotics, particularly since it permits them to rebuild their population size, since, while they are well below the ecological constraints of their environment their population can grow exponentially as a function of time, e.g., doubling in size every hour.

However, a large part of the problem has to do with the fact that while genes may originate in a specific strain of bacteria they tend not to remain there.  They get shared with other strains of bacteria.  They are exchanged by means of plasmids, bare rings of DNA.  In fact a gene for resistance to certain antibiotics that is present in some strains of e. coli and salmonella resides on just such a plasmid.  Alternatively, some genetic traffic takes place by means of bacteriophages ("phages") which are viruses that infect bacteria., often existing in a symbiotic relationship with the bacteria that they infect..

Thus if antibiotics get used as they shouldn't be (when unnecessary, for a period that is shorter than the recommended time, at a reduced dosage, or less frequently than prescribed) they are more likely to result in the introduction of antibiotic resistance genes which will get exchanged with bacteria that weren't exposed to the antibiotics in the first place.  Furthermore, some may end up on plasmids or in phages that already have genes for resistance to other antibiotics and end up in more dangerous strains of bacteria.

雨涵 张
雨涵 张

It is like evolution, Bacteria that survived the antibiotic environment pass on their resistant genes to the next generation and most of them or all of them manage to also become a superbug. Superbugs emerge from all others only when there are anti-biotics, just like how heroes emerge in trouble times.

Lim Li Yang
Lim Li Yang

@Uzair Khan  It's analogous to the survival of the fittest: Not taking antibiotics as prescribed by doctors will leave behind a small amount of hardy pathogens. The weak ones are killed but these hardy ones will then procreate, mutate and ultimately develop a resistance towards the drug.

Robbie Barnes
Robbie Barnes

 What % do you think the Pharma has put toward living longer? You're right Pharma makes the meds, but doesn't prescribe them but who keeps the doctors updated on "what's hot" (most cases the patients become the "legal" lab rat). The well dress person that comes in the doctors office while you wait, who pulls their roll around suitcases, that's Pharma. I agree they have helped and I understand they have to make a profit after all the over-head but after the patent goes "public" to say, the generic shouldn't cost e.i $600.00 for 30 tabs. Fact, most of the "name brand" companies that researched the medicine from the beginning, open a generic named company to make more of a profit. Please don't think this huge profit goes back into more research. I could go on and on about this topic but I get the feeling it's a waste because it simply falls into politics and would go round in circles. 

N A
N A

@Lim Li YangThis explanation seems insufficient to me. Then wouldn't those resistant, strong ones not be affected by the antibiotics when you take them "only when you need them", also? 

Lim Li Yang
Lim Li Yang

@Jon Poulter @invalid id @N A @Lim Li Yang  Allow me to expand my explanation. If a doctor prescribes a drug that is required to be taken once, 2 pills a day for a week. Let’s say you only take a pill a day for 5 days because the symptoms ends on the 5th day.


The first time you take the pills, it kills let’s say 8,000 out of the 10,000 pathogenic bacteria. the tad more drug-resistant 2,000 ones then procreate to produce 6,000 bacteria. The pill you take the second day then kills 5,900, leaving behind 100 much more resistant bacteria. These then reproduce. This cycle continues for 5 days and more and more drug-resistant “superbugs” are selected over the weaker ones. @雨涵 张  More and more drug-resistant genes are passed on from one generation to the next. That is why bacteria mutate very easily (due to their short generation time). Hence, you are required to take the drugs according to your prescription even when the symptoms stop showing.


In this case, you have a flu but you take antibiotics that are meant for bacteria. @Jon Poulter You are needlessly exposing the bacteria to the antibiotics. Once the flu symptoms stop showing, you stop taking the drug, thus leaving behind more drug-resistant bacteria each time you take it. The same goes for animals. 

Jon Poulter
Jon Poulter

@invalid id @N A@Lim Li YangIsn't it more to do with, rather than being "hardy", the more you needlessly expose millions of bacteria to antibiotics, the higher the chances of one genetic mutation rendering the mode of action of that antibiotic useless against the mutated bacteria.  It's not that they're tough, it's that Darwin chap being right again.

invalid id
invalid id

@N A @Lim Li Yang  those strong bacteria are obviously not yet killed by the antibiotics. Why? because usually doctors will prescribe u antibiotics with duration of use in 5 days. U should not stop taking it as u wish. If u stop taking it before the time or before the antibiotics not finished yet, thats gonna be a trouble. The bacteria are not yet wipe out completely from your body because the doses of the antibiotics are not enough. Why not enough? because u not finish it properly..u stop taking it while it still not killing all the harmful bacteria


Share

Feed the World

  • How to Feed Our Growing Planet

    How to Feed Our Growing Planet

    National Geographic explores how we can feed the growing population without overwhelming the planet in our food series.

See blogs, stories, photos, and news »

Latest From Nat Geo

See more photos »

Shop Our Space Collection

  • Be the First to Own <i>Cosmos: A Spacetime Odyssey</i>

    Be the First to Own Cosmos: A Spacetime Odyssey

    The updated companion book to Carl Sagan's Cosmos, featuring a new forward by Neil deGrasse Tyson is now available. Proceeds support our mission programs, which protect species, habitats, and cultures.

Shop Now »