Dr. Felix Liauw vividly recalls the moment he first held his son, Obelix.
“He was perfect. Our little miracle,” shared the 40-year-old pediatrician.
After seven years of wanting to start a family, both he and his wife felt immense joy with the arrival of their first child. Unfortunately, that joy quickly turned into concern when they noticed that Obelix couldn’t keep food down—he would vomit and have diarrhea after almost every bottle, up to eight times a day.
His wife, suspecting a potential allergy to breast milk, modified her diet.
However, despite these efforts, Obelix’s symptoms continued, leading to his admission to neonatal intensive care for rehydration when he was just two weeks old.
“He just wouldn’t stop crying all day,” Liauw recounted, from his home in Bekasi City, Indonesia.
“If we didn’t feed him, he seemed fine, but he was always so hungry.”
After consulting a pediatric nutritionist, they tried a specialized milk formula. Sadly, it didn’t work. Obelix’s weight fell from 2.4 to 2.2 kilograms (about 5 pounds).
At one month, he required a feeding tube as his hospital stay in Jakarta revealed a bowel infection. Despite various antibiotics being prescribed, nothing seemed effective.
Further blood tests ultimately confirmed a diagnosis of congenital short bowel syndrome, a rare condition preventing him from digesting food, which prolonged his hospital stay.
Tragically, Obelix developed sepsis, a serious life-threatening condition caused by infection.
As tests showed that the antibiotics were failing, he passed away in the hospital on February 12, 2020, only three months and two weeks old.
No autopsy was performed, but his parents are convinced that antimicrobial resistance contributed to his death.
Antimicrobial resistance (AMR) is recognized as a major global health crisis. The World Health Organization (WHO) defines AMR as the process by which bacteria and other pathogens evolve in ways that render medications ineffective.
This isn’t a new issue—researchers in Oxford identified bacteria that could resist penicillin nearly a century ago, even before it became widely adopted.
By the 1980s, multidrug-resistant infections were spreading globally. Awareness has grown since then, yet the danger has only intensified.
Following Obelix’s death in 2021, studies linked AMR to an alarming 4.7 million fatalities around the globe, a figure that could soar to as much as 39 million annually by 2050, according to WHO estimates.
One principal factor behind this resistance is the misuse of antibiotics in both humans and agriculture, thereby promoting ‘superbugs’ that are tougher to combat.
Hence, WHO advises against self-medication with antibiotics and emphasizes the importance of completing prescribed courses.
Nonetheless, data from the past five years suggests that over 40% of antibiotics have lost their effectiveness for common conditions like urinary tract infections.
“These findings are really concerning,” stated Dr. Yvan Hutin, who heads WHO’s AMR department. “With antibiotic resistance on the rise, options for treatment are dwindling, putting lives at risk.”
Despite increased awareness, global consumption of antibiotics continues to rise. It’s not just human use—agriculture also utilizes significant amounts antimicrobial drugs, often for growth promotion in livestock, a practice prevalent far beyond Liauw’s landscape in Indonesia.
The European Union has taken significant steps, banning the use of antibiotics as growth agents for livestock within its borders and extending this regulation to include all imports by September.
In contrast, the United States maintains policies that still allow such practices, showing a reported 16% increase in antimicrobial sales for food-producing animals for 2023-2024. Some of this uptick correlated with an outbreak of Avian metapneumovirus and bird flu, as noted by the FDA.
Mallory Smith died at 25 in Los Angeles due to an infection that antibiotics were ineffective against.
Diagnosed with cystic fibrosis at just three years old—a genetic disorder that thickens mucus in the lungs—Smith’s family held out hope for a cure.
But as she neared her teenage years, her lungs became infected with B. cepacia, a particularly aggressive bacteria resistant to most antibiotics.
This infection resulted in around 70 hospital stays.
By 2016, antibiotics had failed her. Although she underwent a double lung transplant, the infection persisted, leading to her passing two months later in November 2017.
“The antibiotics simply couldn’t overcome the infection,” her mother, Diane Shader Smith, recounted.
“It was like a fire you thought you extinguished, but the embers lingered, flaring up again more intensely and unpredictably.”
Before Mallory’s passing, doctors had secured emergency FDA approval for bacteriophage therapy—a form of treatment that uses naturally occurring viruses to target bacteria.
However, identifying the right phage to combat each patient’s unique infection poses a considerable challenge, given the immense diversity of phages available—scientists believe there might be a trillion for every drop of water or grain of sand.
Thus far, the use of phage therapy remains limited to certain countries, although there’s hope for it to address the looming crisis of antibiotic resistance.
While phage therapy didn’t save Mallory, her mother confirmed that it had indeed begun to show effects.
Throughout her life, Mallory chronicled her experiences, often noting how the sea brought her comfort, with the saltwater soothing her troubled lungs and surfing helping to calm her.
“Losing Mallory was devastating, but raising awareness has given me direction,” Shader Smith expressed.
Since her daughter’s death, she has traveled extensively to spread awareness about AMR and the possibilities of phage therapy.
WHO maintains that phage therapy is generally considered safe since it doesn’t harm human cells, but more research remains essential before it can be widely implemented.
This treatment is not a panacea for all bacterial infections; like antibiotics, phages have the potential to release endotoxins, which can trigger severe inflammatory responses, including septic shock.
Unlike Mallory’s situation, AMR predominantly affects those in lower-income countries—such as Southeast Asia, where Liauw is from, as well as South Asia and sub-Saharan Africa, according to the US National Institutes of Health.
These resistant bacteria circulate globally, impacting health systems across all regions, as highlighted by Dr. Xin Deng from the City University of Hong Kong.
The difference between countries, he pointed out, often lies not in the germs but in the resources available to address them.
Factors such as a country’s ability to prevent infections, diagnose accurately, control environmental contamination, and enforce regulations play crucial roles.
For some, even treating minor wounds could present significant challenges if AMR continues to spread, raising the threat of uncontrolled infections.
“Certain bacteria naturally carry higher AMR risks,” Dr. Deng noted, mentioning Pseudomonas aeruginosa as a prime example, which causes serious conditions like meningitis and pneumonia—especially dangerous for individuals with cystic fibrosis, like Mallory.
Deng advocates for improved antibiotic practices, public education, healthcare training, vaccination initiatives, and investments in research and diagnostics as essential steps forward.
He warned that without action, the AMR crisis will only worsen, becoming increasingly difficult and costly to tackle.
Research indicates that by 2050, AMR could result in $1.7 trillion in annual global GDP losses.
As momentum builds to address antimicrobial resistance, over 170 countries are formulating action plans. WHO member states have agreed to an updated strategy aimed at reducing AMR-related deaths by 10% by 2030.
This new approach promotes a reduction in antimicrobial usage in agricultural systems and emphasizes the importance of sanitation and hygiene. It also calls for better laboratory testing and surveillance—steps that may ultimately help in cases like Obelix’s.
For Liauw, advocating for this cause is a meaningful way to honor his son.
“We need to adopt a more comprehensive approach to diagnosing infections, moving beyond just identifying certain symptoms. My son’s case illustrates how deadly AMR can be,” he asserted.
“This kind of risk isn’t just theoretical—it can have tragic consequences.”
