Imagine a world without antibiotics.

Infections that we now routinely dispatch are again life-threatening. Cures for pneumonia, urinary tract infections, venereal diseases and a host of others are nonexistent.

Antibiotics are vital to prevent infection for many medical procedures. Cancer chemotherapies that deplete the white blood cells that protect against infection and organ transplants that require lifelong suppression of the immune system to avoid rejection would be a thing of the past.

Surgery? Everything from coronary bypass to hip replacements becomes incredibly risky once the surgeon cuts through the protective skin. And the list goes on.

A world without antibiotics is very different from the one we live in now, yet we are at real risk of moving in this direction without changes to drug discovery and drug use.

The culprit is evolution. Antibiotics are unique among drugs as their use causes their demise. If you use it, you lose it. Resistance to antibiotics is now a global problem that is having a massive effect on the practice of medicine. The recent media attention to the impact of superbugs is a revelation that infectious disease specialists have been aware of since the first use of penicillin more than 60 years ago.

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Antibiotics are chemicals (many produced by bacteria themselves) that block the growth of bacteria. Each bacterial cell, even those that do not cause disease, is equipped with genes that protect it from the natural chemicals in the environment, often including antibiotics. These organisms have been around for more than four billion years; we’ve been using antibiotics for less than a century. We’re no match for the numbers and evolutionary history of bacteria. Antibiotic resistance is natural and unavoidable.

Last week the Ontario Medical Association released a report titled “When Antibiotics Stop Working,” calling on the provincial and federal governments to address this growing crisis of antibiotic resistance while there is still time. The doctors warn against overuse of antibiotic medicines and recommend governments enact regulatory changes to slow the threat.

These recommendations are a good start but not a complete solution. In addition to ensuring we use antibiotics wisely, we desperately need new drugs. The problem now is that while resistance keeps evolving, we have few new drug candidates in the pipeline. Furthermore, the world has shrunk and we’re only a plane ride away from drug resistant bacteria anywhere on the planet. This is a race that may be over and the bacteria the victors if we don’t act fast.

Ironically, at the same time that we’re in need of new drugs, the pharmaceutical industry has largely abandoned antibiotic discovery. The reasons are a complex mixture of scientific and economic challenges. The majority of the antibiotics in use today were discovered before 1960. Identifying new molecules that kill bacteria without human toxicity has proven very difficult and expensive. The clinical trials that governments rightly insist companies undertake to prove new drugs are safe and effective have become especially challenging and costly for antibiotics.

Faced with a choice between investing in new antibiotics or finding cures for other diseases, the pharmaceutical industry has elected to drop antibiotic development. Since it takes more than a decade to bring a new antibiotic from the lab to the patient, we are facing a formidable gap for years to come.

Yet there is room for optimism. We have incredibly powerful scientific tools to sequence bacterial genomes, to discover and synthesize new molecules, and to screen these by the tens of thousands for antibiotic activity using robotic platforms. This advanced technology is providing the push for the discovery of new drugs. Much of this research is happening in universities and small biotechnology firms.

What is needed is a pull from the pharmaceutical industry and government to develop these discoveries into actual drugs. This will require dialogue between all the stakeholders. This is happening in the U.S. and Europe. What will be Canada’s response? We need cooperation between the funders of academic antibiotic research, government drug regulators, public health representatives, university researchers, clinicians and the pharmaceutical industry to frame the answer to this crisis: a Canadian action plan for antibiotic resistance.

The outcomes of such a plan could galvanize efforts to solve the antibiotics problem and also stimulate new investment in the Canadian pharmaceutical and biotechnology industries.

The bacteria are not waiting to advance, neither should we.