Quick Bites
- The Centers for Disease Control and Prevention (CDC) have confirmed nearly 20,000 cases of cyclosporiasis since May 1. That compares to 1,180 confirmed cases in 2025. This year’s total includes multiple outbreaks of Cyclospora infection, including the largest ever outbreak from the parasite linked to iceberg lettuce imported from a Taylor Farms growing and processing operation in Central Mexico. The CDC officially declared that outbreak over as of Sept. 11.
- The CDC also reported another death in a Salmonella outbreak linked to backyard poultry flocks. The outbreak stretches across 46 states and Puerto Rico. A total of 1,061 cases have been confirmed with two deaths, one in Washington and another in Georgia. About one quarter of the patients are children younger than five years old.
- In the UK, three Salmonella outbreaks that have affected more than 500 people and caused two deaths seems to be easing. The rate of people getting sick appears to be slowing down, according to the latest data from the UK Health Security Agency, Food Standards Agency and Animal and Plant Health Agency.
- Researchers from the U.S. Food and Drug Administration (FDA) and CDC shared information about whole genome sequencing (WGS) with their counterparts in EU countries at the recent Science Meets Policy conference in Italy. WGS can help public health officials with surveillance of the food supply and incident investigations but cannot be used on its own to identify the source of outbreaks. New European Commission regulations related to sharing WGS pathogens associated with foodborne outbreaks came into force in August.
Today’s Topic: Antibiotics
In June of 1942, there was only enough penicillin in the United States to treat ten patients. Then FDR’s War Production Board stepped in with orders for mass production.
By D-Day, June 6, 1944, there were 2.3 million penicillin doses loaded on board ships and planes that landed in France. From that day forward, the antibiotics cut the number of Allied troops who died after being injured in action by an estimated 15 to 20 percent.
Over 646 billion units of penicillin were produced by Victory in Europe (V-E) Day on May 8, 1945. Civilian access to penicillin started the following June.
Today, the World Health Organization’s list of medically important antimicrobials identifies more than 20 distinct categories authorized for human use. The precise number requires understanding what these classes do differently and why doctors choose one over another. Antimicrobials include substances such as antibiotics, antifungals, disinfectants and antiseptics.
But we’ve come full circle since World War II. Mass production and the development of new miracle antibiotics are being overshadowed by reports that we are running out of antibiotics and have reached a point where there are very few in the pipeline and potentially no treatment alternatives left for some bacterial infections – some caused by foodborne bacteria.
Just before the pandemic hit, the Centers for Disease Control and Prevention, under Dr. Robert R. Redfield, issued a 150-page report titled Antibiotic Resistance Threats in the United States.
It said we should:
- Stop referring to a coming post-antibiotic era — it’s already here: You and I are living in a time when some miracle drugs no longer perform miracles, and families are being ripped apart by a microscopic enemy. The time for action is now, and we can be part of the solution.
- Stop playing the blame game: Each person, industry and country can affect the development of antibiotic resistance. We each have a role to play and should be held accountable to make meaningful progress against this threat.
- Stop relying only on new antibiotics that are slow to get to market: Sadly, germs will one day render those ineffective, too. We need to adopt aggressive strategies to keep germs away and prevent infections from occurring in the first place. Robust food safety measures are part of this strategy.
- Stop believing that antibiotic resistance is a problem “over there:” It is a mistake to think that this is just a problem in someone else’s hospital, state or country. Antibiotic resistance has been found in every U.S. state and in every country across the globe. No place has been spared from antibiotic resistance, but everyone can take action, from handwashing to improving antibiotic use.
Each year in the United States, more than 2.8 million people are infected with bacteria that are resistant to antibiotics, according to the 2019 CDC report. These “superbugs” are responsible for 35,000 deaths annually.
The ill-timed CDC report did not receive the attention it deserved because of the headline-grabbing pandemic that broke out shortly after the study’s publication. One of its findings was that one-third of antibiotic prescriptions are not needed, but are written to humor the patient
In the heady early days of antibiotic use, resistant infections did occur, but a steady flow of new antibiotics provided alternative treatments. Once resistance to a specific antibiotic developed, it was possible to simply switch to other treatments.
However, antibiotic development has now slowed to a trickle.
The last new antibiotic class reached the market in 1987. Since then, innovation has stagnated, with only a few novel antibiotic classes currently in the drug pipeline.
Consequences are felt worldwide, as an increasing number of bacterial infections are again becoming difficult to treat. Of particular concern is the lack of antibiotics effective against Gram-negative bacteria.
Among foodborne illnesses, E. coli is a Gram-negative bacterium that lives in the gastrointestinal tract.
Infection with Shiga toxin-producing E. coli (STEC) can lead to a serious health condition called hemolytic uremic syndrome (HUS), which can cause kidney failure, permanent health problems and even death.
Gram-negative bacteria also cause infections such as pneumonia, bloodstream infections, wound or surgical site infections, and meningitis in healthcare settings.
These infections can be hard to treat because the bacteria that cause them are becoming resistant to common antibiotics. Resistance to most or all antibiotics has also been reported.
Of all antibiotics sold in the United States, approximately 80 percent are used in animal agriculture, with about 70 percent of these deemed “medically important” for their significance to human medicine.
Antibiotics are administered to animals in feed to marginally improve growth rates and to prevent infections, a practice projected to increase dramatically worldwide.
There is scientific concern that antibiotic resistance in humans is promoted by the widespread use of nontherapeutic antibiotics in animals. Resistant bacteria might be transmitted to humans through direct contact with animals, exposure to animal manure, consumption of undercooked meat, or contact with uncooked meat or surfaces meat has touched.
Beginning in 2023, certain medically important antimicrobial drugs for animals that had been available over the counter became available only by prescription. This means that all medically important antimicrobials approved for use in animals now require the authorization of a licensed veterinarian.
That requirement is a major step in the FDA’s ongoing effort to promote judicious use of antimicrobials in animals.
Sales and distribution of medically important antimicrobial drugs used in US livestock rose 16 percent from 2023 to 2024 but are still 27 percent lower than peak sales in 2015, according to the FDA Center for Veterinary Medicine.
The Pros: Arguments for heightened concern
- Saves modern medicine: Major procedures like chemotherapy, organ transplants and joint replacements rely on effective antibiotics. Public concern drives the funding needed to keep these procedures safe.
- Curbs massive financial losses: Global economic damages from antibiotic resistance are projected to hit $412 billion annually by 2035. Raising awareness of this impact prompts governments to invest in early containment.
- Encourages stewardship: Fear of antibiotic resistance forces hospitals to implement stewardship programs, decreasing the 33 percent of prescriptions that are completely unnecessary – such as for viral colds or flu.
- Spurs new drug innovation: Public anxiety pressures pharmaceutical companies and governments to fund the discovery of new antimicrobial classes.
- Protects the human microbiome: Awareness of growing antibiotic resistance encourages clinicians to prescribe the shortest effective doses, minimizing destruction of healthy gut bacteria.
The Cons: Complexities and criticisms of current narrative formats
- Can cause treatment delays: Over-correcting or hesitation due to "antibiotic fear" can lead physicians or patients to delay taking necessary antibiotics, turning curable bacterial infections into sepsis.
- Perpetuates "patient blame" misconceptions: Standard awareness campaigns often hyper-focus on patients "finishing the course," which newer infectious disease science notes can sometimes cause more resistance than stopping early once cured.
- Disproportionate burden on developing regions: Strict restriction policies designed for wealthy nations can inadvertently block access to basic, life-saving medications in low-resource settings, where untreated bacterial infections remain the leading cause of death.
- Overlooks non-clinical drivers: An overemphasis on medical prescriptions sometimes eclipses the massive role that agricultural runoff, poor sanitation and animal farming play in breeding resistant bacteria.
- Public fatigue and anxiety: Constantly messaging an impending "post-antibiotic apocalypse" without providing immediate, actionable tools can induce public apathy or panic regarding basic healthcare.
Our take
A “discovery void” might sound like an episode of Star Trek, but its reality here on Earth is that we’ve been in something of a dry spell when it comes to antibiotics.
The concern, of course, is that antibiotic resistance is dangerous. The resulting “superbugs” kill.
Developing a new antibiotic is extremely difficult. The details are complex. It’s an expensive and lengthy venture. There might be fast money in some drug development, but not in antibiotics. And there’s not a lot of existing know-how to tap.
Still, there is hope.
By the numbers
$55,300,000,000 – The value, in U.S. dollars, of the global antibiotic market in 2025.
$57,600,000,000 – The projected value, in U.S. dollars, of the global antibiotic market in 2026.
$74,000,000,000 – The projected value, in U.S. dollars, of the global antibiotic market by 2033.
3.6 – The percentage of the expected compound annual growth rate (CAGR) for the antibiotic market.
39.3 – The percentage of global antibiotic sales in North America, which dominates the market.
7 – The percentage of the antibiotics segment held by generics.
18.1 – The percentage of antibiotic sales from the Cephalosporin segment.
What It Means
Antibacterial agents are in clinical and preclinical development, according to the World Health Organization (WHO). This means there is life in the old antibiotic pipeline.
According to the WHO, this is the state of the antibiotic pipeline as of 2025: A total of 90 products were identified in clinical development – 50 traditional antibacterial agents and 40 non-traditional agents. Only 15 qualify as innovative, and only five target the most critical priority pathogens.
Of the 50 traditional antibacterial agents:
- 45 – 90 percent – target WHO bacterial priority pathogens, including 18 – 40 percent – targeting drug-resistant Mycobacterium tuberculosis.
- Four – 8 percent – are being developed for C. difficile, and one – 2 percent – for H. pylori.
With a likely success rate of 10 percent to 20 percent from phase I trials to approval, only a few of the substances can be expected to reach the market within 10 years.
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