Reader Comments

Post a new comment on this article

Authors' response to Johnson.

Posted by plosmedicine on 30 Mar 2009 at 23:52 GMT

Author: 'Kevin' 'Foster'
Position: Research Associate
Institution: Harvard University
Submitted Date: April 03, 2006
Published Date: April 3, 2006
This comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.

Johnson is quite correct to point out that there is a widespread problem of overuse of antibiotics in agriculture, which we ourselves refer to in our article. And indeed, it is clear that we should do our best to minimise this. However, it is also not clear that reductions in agriculture will solve the problem of antimicrobial resistant pathogens in our own societies because humans by no means share all of their pathogens with livestock.

Furthermore, we fully accept that implementing any program where antibiotics are not prescribed to all individuals that might benefit would be a very difficult thing to do. We do not question this and again it is stated as such in our article.

Our point is this, what if it comes to the point where we no longer have any antimicrobials at all to treat the really serious infections? Would it have been better (or indeed effective) if we had used less antimicrobials for minor infections along the way? That is, could we have saved lives at the cost of slight discomfort to others? If this is the case then it would be better to realise this now and act upon it than be in a situation where we can no longer save those with serious bacterial infections.

As to the suggestion that my coauthor and I, and our families, should refrain from all antimicrobial use, I fear this is reductio ad absurdum. We are not suggesting that all individuals refrain from all antimicrobial use. We are suggesting that in some cases, where the prognosis is good, it may be better to allow some individuals to fight infection alone and thereby reduce the load of resistant pathogens that affect individuals in more serious infections in the future. However, it is also important to note that our article is not saying that this is definitely a workable idea. We are far from fully understanding the societal cost of antimicrobial resistance and how best to combat it. Our goal was to raise this difficult idea in order to stimulate further discussion and research into the question of whether we are really facing a tragedy of antimicrobial resistance.

No competing interests declared.