Saving Antibiotics: One Mother’s Journey
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Just five years ago, the World Health Organization warned, “A post-antibiotic era—in which common infections and minor injuries can kill—far from being an apocalyptic fantasy, is a very real possibility for the 21st century.” This month, the Centers for Disease Control and Prevention declared that it is already here.
by Everly Macario
One mom fights to save lives. Everly Macario’s son Simon was a happy, healthy baby until, at around 18-months old, he came down with a fever. She took him to the hospital in the evening, and by the following morning, he was gone. Although she holds a PhD in public health from Harvard, she had never heard of the superbug MRSA until the very moment the autopsy results came back. She had not realized the extent of the antibiotic-resistance problem. Everly wants to make the term MRSA as familiar a household term as AIDS and hopes that Simon’s life and death will serve as a catalyst for major and positive change – “I want people to wake up and realize that this isn’t something that just happens to other people.”
Everly holding simon in potomac. Photo credit: everly Macario, 2003.
It happened 15 years ago, and it still haunts me as if it were yesterday. It is Friday, April 16, 2004. The sky is all blue, the sun a crisp yellow. Flowers have sprung everywhere. The temperature is just perfect. You can’t help but take a deep breath in. My husband, Jim, and I wake jarringly to a primal, terrified shriek let out by our 18-month-old son, Simon. We touch Simon’s forehead and feel a slight fever, and my husband decides this is cause enough to take Simon to the emergency room.
When I arrive at the emergency room later, Simon is sleeping on his daddy’s lap looking angelic. The reddish tint from his curly blondish hair glows in such a way that it makes me think there is a halo surrounding his beautiful, cherub-like face. Jim says that the doctors ran a standard battery of tests (chest X-ray, oxygen-level test) only to speculate that Simon may be an asthmatic kid.
We notice Simon’s lips are blue as we walk out of the emergency room doors. The doctors, once again, measure his oxygen level and inform us that Simon is within normal range. On the way home, Simon leans over, points to a flower and for the first time utters the word, “flower.” At his age, his personality was really starting to blossom.
Simon with his sister, elena, and mom, everly. photo credit: Everly Macario, 2003.
That afternoon, Simon’s nostrils are flaring, and he is breathing so heavily his chest is expanding and contracting, in and out. Before I know it, the ambulance arrives; the EMTs apply an oxygen mask to Simon’s face. As soon as Simon is wheeled into the emergency room, doctors hook him up to everything imaginable (oxygen, nebulizer, IVs for medication, pain relievers). “Your child is very, very sick. Your child is very, very sick.” Pediatric emergency room doctors sit me down and tell me that Simon has an infection, but the source is unknown, and they are going to administer a broad-spectrum antibiotic. Doctors keep coming in and out of the room with updates–basically, Simon has gone into septic shock, and his blood pressure is dropping precipitously.
By 10:00 p.m., I knew in my soul Simon was dead. The Attending said that they had to get Simon on ECMO (“extracorporeal membrane oxygenation” or the “heart-lung machine”) as this was “his only chance.” On April 17, 2004, Simon was pronounced dead at 12:45 p.m., without a precise cause of death. Two months later, the autopsy revealed that Simon had contracted an antibiotic-resistant bacterium called “MRSA” or methicillin-resistant Staphylococcus aureus, specifically a new strain or “superbug” called “community-associated MRSA.” The theory is that Simon touched something and brought his fingers to his mouth, and the bacteria got in his lungs. In the autopsy, his lungs were like Swiss cheese.
Those 24 hours rocked my world forever. I have a doctorate from the Harvard T.H. Chan School of Public Health and had never heard of MRSA. I have since been telling Simon’s story for documentaries, television, radio, newspapers, magazines, and blogs; helped found a MRSA Research Center; visited farms that do not use antibiotics in the raising of food animals; met with departments of health; served on Centers for Disease and Control and Prevention (CDC) panels; and engaged in legislative advocacy with concerned family members, pediatricians, infectious disease doctors, microbiologists, chefs, restaurateurs, farmers, and ranchers. I most recently joined the Small World Initiative, an innovative and effective platform to continue engaging and spreading the word.
The Sobering Reality
The more we use antibiotics, the less effective they become. Bacteria are constantly mutating and finding new ways to survive the antibiotics used to eliminate them. This happens naturally. However, using antibiotics unnecessarily (when an antibiotic is not called for) and inappropriately (using the wrong antibiotic, at the wrong dose, and for the wrong duration), accelerates this process and drives resistance.
Antibiotic resistance occurs when an antibiotic kills weaker bacteria but leaves stronger bacteria to multiply with the next generation of bacteria experiencing the same process—the weakest bacteria die when faced with antibiotics leaving the stronger bacteria to replicate and become even stronger, evolving into “superbugs.” When bacterial infections are no longer vulnerable to the effects of antibiotics, this is when “antibiotic resistance” occurs—antibiotics become less effective or ineffective altogether.
The painful truth is that Simon’s story was not an isolated incident.
The Sobering Facts
30%+ of antibiotics prescribed in humans in the U.S. are unnecessary. This happens when antibiotics are used inappropriately for viral instead of bacterial infections, a wrong antibiotic is used, the wrong dose is used, or the antibiotic is not taken during the prescribed length of time.
70%+ of medically important antibiotics are sold in the U.S. for food animal production.
Too few antibiotics are in the developmental pipeline.
In the 1980s, 42 new antibiotics were approved.
In the 1990s, 21 new antibiotics were approved.
In the 2000s, 15 new antibiotics were approved, and only 4 of them represented new classes of antibiotics.
For pharmaceutical companies, antibiotic drug development is a poor return on investment compared to drugs used regularly such as those for high blood pressure or cholesterol.
Progress to Date
The U.S. Food and Drug Administration (FDA) published Guidance for Industry #213 asking drug companies to remove growth promotion as an approved indication for products used in food animals. It is a voluntary policy, but all drug companies have agreed to comply.
Guidance #213 also ends the over-the-counter sale of antibiotics used in food animal feed and drinking water.
Note, however, #213 ended antibiotics for growth promotion but does not address antibiotic use for disease prevention in food animals.
The FDA released draft guidance for voluntarily bringing all medically important antibiotics used in food animals under veterinary oversight.
Tyson Foods, McDonald’s, Chick-fil-A, Subway, and Perdue Farms are all either reducing or eliminating antibiotics used by their meat suppliers.
The Centers for Medicare and Medicaid Services (CMS) finalized a policy that requires U.S. hospitals to adopt antibiotic stewardship programs to participate in Medicare and Medicaid.
The Macario Family on Simon’s SECOND and LAST christmas. photo credit: everly macario, 2003.
More to Do
Antibiotic resistance is a problem we can fix. What can you do?
Support Small World Initiative’s efforts to tackle the crisis by sharing your story, participating in their Do Something About Antibiotics Challenge™ and other programs, and supporting their work.
Tell everyone you know about the antibiotic resistance crisis—this is important for raising awareness.
Next time a doctor prescribes antibiotics, ask if this is really necessary.
If you do take antibiotics, take the full course as prescribed—even if you start to feel better after a couple of days.
Buy poultry, beef, and pork from farms that do not use antibiotics in the raising of food animals.
Talk with your veterinarian about when antibiotics are really needed for your pets (companion animals).
Contact your Congress people to get them to pass legislation to provide financial incentives in the development of brand-new antibiotics.
Your children will thank you for doing your part to save antibiotics!
Remembering and Honoring Simon’s Life
This story is part of our series: Superbugs – Real People, Real Stories.
About Superbugs – Real People, Real Stories: This series is part of the Small World Initiative's public health campaign to raise the alarm about the severity of the growing global antibiotic crisis and share what people can do to protect themselves and their loved ones from antibiotic-resistant infections (commonly referred to as “superbugs”). The series shares the powerful stories of real people who understand the true consequences of antibiotic resistance and want you to learn before it is too late. Recounting journeys filled with enormous fear, heartbreaking loss, and extraordinary triumph, we hope these stories engender a strong sense of urgency and compel readers to act.
If you have a story to share, please email info@smallworldinitiative.org.
