Get ready for antibiotic-resistant strep throat

Scientists find signs that the germ causing strep throat and flesh-eating disease may be moving closer to resistance to penicillin and other related antibiotics.

Antibiotics have had a pretty spectacular run. The modern “antibiotic era” has ushered in one of the most successful forms of chemical treatment in the history of medicine. Antibiotics have been remarkable in controlling infectious diseases that were the leading causes of human morbidity and mortality for most of human existence.

But bacteria are tough little survivors and aren't going down without a fight. And in fact, they are proving victorious in their microscopic war against antibiotics. Now we have entered the “antibiotic resistance era,” in which bacteria are changing in response to the use of antibiotics – getting stronger and rendering the medications less and less effective.

The World Health Organization (WHO) calls antibiotic resistance “one of the biggest threats to global health, food security, and development today.” As the organization points out, “A growing list of infections – such as pneumonia, tuberculosis, blood poisoning, gonorrhoea, and foodborne diseases – are becoming harder, and sometimes impossible, to treat as antibiotics become less effective.”

The latest germs making a go of it appear to be those that cause strep throat and the ever-lovely flesh-eating disease, according to infectious disease scientists who have published a study in the Journal of Clinical Microbiology.

Earlier in 2019, researchers reported that they had found two related bacterial strains of Streptococcus pyogenes with reduced susceptibility to ampicillin, amoxicillin and cefotaxime, antibiotics commonly used to treat infections caused by the strains.

“This concerning report led us to investigate our library of 7,025 genome sequences of type emm1, emm28, and emm89 S. pyogenes clinical strains recovered from intercontinental sources for mutations in pbp2x,” write the authors of the new study.

Houston Methodist Research Institute explains that the researchers “exploited their genome sequence library derived from 7,025 group A streptococcus strains collected over several decades from countries around the world. Of these, they discovered approximately 2% with gene mutations of interest. The researchers then tested the strains in the clinical microbiology laboratory to confirm their decreased susceptibility to beta-lactam antibiotics.”

“If this germ becomes truly resistant to these antibiotics, it would have a very serious impact on millions of children around the world,” said James M. Musser, M.D., Ph.D., lead author of the study and chair of the Department of Pathology and Genomic Medicine at Houston Methodist Hospital. “That is a very concerning but plausible notion based on our findings. Development of resistance to beta-lactam antibiotics would have a major public health impact globally.”

“We could be looking at a worldwide public health infectious disease problem,” adds Musser. “When strep throat doesn't respond to frontline antibiotics such as penicillin, physicians must start prescribing second-line therapies, which may not be as effective against this organism.”

While strep throat on its own isn't dangerous, notes the Mayo Clinic, if untreated it can cause complications, such as kidney inflammation or rheumatic fever; antibiotic treatment reduces those risks. So maybe antibiotic-resistant strep throat isn't the most terrifying thing in the world. But a disturbing point here is that these strains were long thought to lack the gene mutations that could lead to antibiotic resistance – if we don't get a handle on antibiotic resistance, what strains will prove resilient next?

I know that many of us are overwhelmed with doing our part to correct humanity's course when it comes to carbon footprint, consumption, rethinking our treatment of animals, plastic use, et cetera. But we need to add antibiotic awareness to the list.

As WHO notes, “The world urgently needs to change the way it prescribes and uses antibiotics. Even if new medicines are developed, without behaviour change, antibiotic resistance will remain a major threat.”

Here is what we as individuals can do to prevent and control the spread of antibiotic resistance, as advised by WHO

• Only use antibiotics when prescribed by a certified health professional.
• Never demand antibiotics if your health worker says you don’t need them.
• Always follow your health worker’s advice when using antibiotics.
• Never share or use leftover antibiotics.
• Prevent infections by regularly washing hands, preparing food hygienically, avoiding close contact with sick people, practising safer sex, and keeping vaccinations up to date.
• Prepare food hygienically
• Choose foods that have been produced without the use of antibiotics for growth promotion or disease prevention in healthy animals.

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