Antibiotics are used to treat bacterial infections and they are considered as the revolution of the second half of the twentieth century. The first antibiotic, penicillin, was discovered unintentionally by Alexander Fleming in 1928. They do not, however, treat flu or colds that are caused by viruses. Yet, they may be prescribed if a patient develops a complication as a result of viral replication such as a chest infection. Again, this works by treating the bacteria involved and not the virus. They are usually prescribed for a short-term, to reduce the number of bacteria to a very low level to reduce symptoms.
However, the biggest issue that is coupled with antibiotics is the concept of resistance. When the bacteria are not fully killed, some develop resistance. The gene coding for this can be passed on via horizontal gene transfer and all the bacteria, which receive the new gene, are now resistant to the given antibiotic. Thus, a wealth of antibiotics may be prescribed when the infection re-occurs. A similar strategy has also been implemented in the treatment for HIV patients. The therapy is termed ‘HAART’ and it involves prescribing the patient with 3 or more drugs to reduce the chance of resistance stopping the viral reduction. By prescribing more than one drug, there is a higher chance that one will be successful. It is important to note that increasing the number of drugs does lead to side effects which can be highly damaging – such as kidney failure.
One example of a resistant strain is MRSA and this is a major cause of nosocomial infections that is accountable for up to 60% of nosocomial infections in ICU. Moreover in Europe, antibiotic-resistant infections have lead to approximately 25,000 deaths. The costs associated with this are around €1.5 billion per year (Data from CDDEP, 2015).
Over the last few years there has been an evident increase in antibiotic prescriptions. There are many reasons why antibiotics should be prescribed, and these include prevention of further infections, and growth of bacteria. Biofilms can form due to bacteria and these can clog up medical devices such as catheters or infection can occur due to bacteremia. Prescribing antibiotics can be likened to a battle between preventing infections by prescribing antibiotics against increasing the risk of resistance. Antibiotic prescriptions have been rising steadily over the last few years. This may be linked to the increased self-diagnosis that occurs when patients use the internet to find answers for themselves, or read forums online where unqualified members of the public may vouch for hearsay. By prescribing antibiotics for infections, the patients feel like they will ‘get better’ as they have been given medicine, a tangible product that they can allocate their recovery to.
Some bacteria are completely resistant to many antibiotics such as MRSA. For example infections such as urinary tract infection, which are very common, are often mitigated with antibiotics. However, as these bacteria stop responding to the antibiotics, major problems such as recurrent infections can become more evident. Infections that we now consider trivial, were often fatal in the 1930s because of the lack of antibiotics. Even complex surgery was impossible because of the enhanced risk of infection. Modern medicine depends on antibiotics. For example, cancer patients need antibiotics to fight off infection as their immune system is vulnerable and weak. Therefore, if antibiotic resistance escalates any further, this will be one of the major pressures in the 21st century and will undoubtedly threaten the achievements of modern medicine.
The Chief Medical Officer for England, Professor Dame Sally Davies has likened the issue to terrorism, stating that the danger posed by antibiotic resistance is a threat to the nation. She also warned that infections arising after operations could become deadly if no antibiotic can control them. Thus, meaning that routine operations such as vital transplants could become fatal. However, the cases of infections arising post-operation have reduced significantly due to improved hygiene practices which have been implemented since 2003.
Moreover, the economist Jim O’Neill mentioned in his report that nearly 50% of all antibiotics prescriptions were not necessary. This either shows the pressure doctors are under by patients to get a tangible solution to their cold or flu. Or the ‘be safe, not sorry’ regime doctors may be following. It is difficult to conclude which party has the biggest say in this matter, but it is clear that all parties involved now need to consider this issue very carefully.
A review by the UK government gave 10 targets for Summer 2016. The review was chaired by Jim O’Neil. The reasoning behind electing an economist was due to the issue of antibiotic resistance focusing on economy. These included actions such as increasing the awareness of the issue of resistance globally, and this awareness campaign could cost up to $100 million a year. Another action included reducing the occurrence of infection, in order to reduce the need for antibiotics, such recommendations to achieve this include improving access to clean water and sanitation. Another interesting action mentioned in the review is that the number, pay and recognition of people working on infectious diseases is set to improve. To achieve this, it is set to encourage more individuals to consider the field of infectious disease. Lord O’Neill proposed a “play or pay” levy on big pharmaceutical companies; the ones that didn’t invest in research and development would be required to help those that did. By encouraging more research and advancements in this field, the threat can be mitigated.
The promotion of rapid diagnostics may help to reduce unnecessary use of antibiotics. The review highlights that by 2020 any antibiotics are prescribed will need to be firstly be informed by data and testing technology.
However, the last and arguably the most important point of the review focused on the unity required to succeed. The review highlights that animals, food, people and microbes can travel around the world and this means that resistance can too. Thus, even if the problem is overcome in one country – the issue will still remain ubiquitous. By establishing a global agreement the problem can be overcome. Dr. Jennifer Cohn from Doctors Without Borders also highlighted the importance of global action and the little time left in which rational use of antibiotics must be achieved.
Dr Chris van Tulleken, who presented the TV series of ‘Trust Me I’m a Doctor’, recommends that patients should not demand antibiotics from their doctor who will assess whether they are really required or not. Colds, flus and sore throats often do not need antibiotics because they only offer very little improvement but rather over-the-counter remedies are usually more beneficial in these cases. He also reinforced the significance of only taking antibiotics for as long as they are prescribed by a doctor. It is also important to remember to never let another person take them, even if their symptoms are exactly the same as yours.
Antibiotic development in recent times has been disappointing. Many factors are contributing to this, such as the returns pharmaceutical companies would achieve would not be prosperous, the difficulty in demonstrating efficacy and the costs of drug trials and reducing side effects coupled with the demand of cheap antibiotics have meant little progress has been made in such.
Overall, the awareness of this issue has evidently increased and antibiotic resistance, which was once never a problem, has become one of the most important issues facing us today – even though many may not even realize the extent of damage that could arise. In the future, if no alternative antibiotics are developed, even a small trivial cut could lead to a fatal consequence
If you have any ideas on how the antibiotic resistance problem could be tackled before it tackles us, there is an opportunity waiting for you. The Longitude Prize offers you with a sum of £8m if you can raise a method to decelerate the use of antibiotics. Sounds easy? Well, not only are you against 138 teams and counting, but the solution you offer must be quick, cheap and reliable.