The warnings have been forthcoming for quite a while. Even though there are specific and limited diagnoses for taking antibiotics, the trend over many years has been their overprescription, as a way to mollify insistent patients or convey an attitude of “just in case, this may help.” Whether for ear infections in young children or urinary tract infections in older adults, there is evidence that antibiotics are often over-prescribed- so that they’re not benefiting the patient and at the same time may be harming individuals and society at large by allowing for the development of antibiotic-resistant infections. There’s evidence that during the pandemic, doctors prescribed antibiotics unnecessarily and that many older adults continue to demand antibiotics when they would be of no benefit, or use up old pills if they feel an unrelated illness coming on. This is a recipe for disaster, and in fact, we now have evidence that the disaster has arrived.

A new study just published in Clinical Infectious Diseases confirms that older Americans are the most afflicted with antibiotic-resistant infections among all Americans. While older Americans make up only 15% of the US population, they account for more than ⅓ of all deaths in the US from antibiotic-resistant bacterial infections. This new study found that nearly 12,000 deaths a year are the result of such infections and that the health care system (primarily Medicare) spends almost $2 billion a year caring for such severely ill patients. This is no surprise, really, since declining immune systems, in combination with chronic disease (and often congregate living) leave older adults more vulnerable to the spread of antibiotic-resistant infections. And this spread of antibiotic-resistant infections is not limited to the United States. In fact, the CDC estimates that, worldwide, 2.8 million people are infected with antibiotic-resistant infections, leading to 700,000 deaths around the world as a result.

What makes this even worse for vulnerable older adults is that this is primarily a crisis caused by humans, who either abuse or overuse antibiotics or don’t complete their course of treatment when antibiotics are prescribed. Furthermore, there currently exists what’s known as an “antibiotic discovery void.” That is, for the last 34 years, there’s been little in the way of development of new antibiotics, and none of the 43 antibiotics currently under development target the most dangerous, resistant bacteria. The problem of insufficient drug development is further exacerbated by the fact that the return on investment for such development is low. Not only are antibiotics usually given in a short course, but apparently 4 out of every 5 drugs that make it into clinical trials fail to gain FDA approval. So large pharmaceutical companies have little incentive to develop new antibiotics and small companies lack the capital to undertake the research and development, especially with the potential for limited return on their investment. Several large pharmaceutical companies have made investments in the AMR Action Fund, which is a collaborative effort to get 2-4 new novel antibiotics into the pipeline by the end of this decade. However, more needs to be done in both the short and long term.

There is currently a bipartisan bill in Congress- The Pioneering Antimicrobial Subscriptions to End Upsurging Resistance Act (The PASTEUR Act) that further aims to fill the discovery void, and experts continue to urge the federal government and Congress to take up the cause of both better stewardship of existing antibiotic prescribing as well as financial support for emerging new drugs. Whether these efforts take hold and create the impetus for new antibiotics remains unclear. But what is clear is that older adults, both in institutional settings as well as in the community, are at high risk for resistant infections, just one more vulnerability for our older population to shoulder in this troubling time.