WHEN SIR Alexander Fleming received the Nobel Prize for Medicine in 1945, for the discovery and isolation of penicillin (jointly, with Ernst Boris Chain and Edward Abraham who discovered how to concentrate the drug and proposed the correct structure), he gave an interview in which he predicted the situation we now find ourselves in.
“The thoughtless person” he declared, “playing with penicillin treatment is morally responsible for the death of the man who succumbs to infection with the penillin-resistant organism.”
Throughout the Second World War, penicillin was used to treat soldiers with infected wounds as well as bacterial infections such as pneumonia, syphilis, tuberculosis, gangrene, and gonorrhoea. Now most strains of gonorrhoea are resistant to penicillin, as well as other first line antibiotics such as tetracycline, and fluoroquinolones. Some multi-drug resistant strains are even resistant to cefixime, a broad spectrum antibiotic; it’s now no longer recommended to use this family of drugs to treat the STI in case resistance develops in more strains.
Whenever anyone undergoes a surgical procedure they are given antibiotics to reduce the risk of developing bacterial infections that can lead to sepsis. As more and more antibiotic-resistant bacteria develop, the number of people in the UK dying from antibiotic resistant infections will increase. In 2015, 44 000 people in the UK died from sepsis, compared to 35 000 from lung cancer. As more and more antibiotics are rendered ineffective, we risk returning to a world where a simple operation like an appendectomy is a life-threatening risk of infection.
In September, all 193 UN member states agreed to combat the threat of antibiotic resistant bacteria. This was only the fourth time in the history of the UN that they met to discuss a health subject. Margaret Chan, director general for the World Health Organisation (WHO), spoke at the event, calling for medical providers to rely less on antibiotics for disease treatment, and for more innovation in antibiotic development.
Only two classes of antibiotics have reached the market in the last 50 years. There is little profit seen in their discovery. It’s not a sound investment to create a drug, costing in the hundreds of millions, only to have to tell people to refrain from using it in large quantities in case resistance develops. Citizen science programs, such as Swab and Send created by Dr Adam Roberts at UCL, look to harness the energy (and financial backing) of the general public in the hunt for new antibiotic compounds.
There are other uses of antibiotics that we can now curtail. In the US, 80 per cent of all antibiotics sold are used on livestock to promote animal growth. Most of these drugs are often given at a sub-clinical level (i.e. a dose too low to combat a disease) so some bacteria in the animal are killed off but those that are naturally slightly resistant survive to multiply and mutate. This also has the effect of flooding surrounding land with waste run-off still filled with antibiotic compounds. Not only are the animal pathogens becoming more and more antibiotic resistant but the frequency of antibiotic resistance in other bacteria (such as those found in the soil and waste water) increases. The use of antibiotics to promote animal growth was banned by the EU in 2006, though it wasn’t completely phased out until 2011.
Tackling the increase of antibiotic resistance may seem daunting, but the signatories to the UN declaration agreed with the WHO to commit to innovation in antibiotic development, increase public awareness of the threat of antibiotic resistance and to develop regulatory systems for human and animal antibiotic use. As individuals we can play our part by only taking antibiotics when prescribed by a doctor, and always finishing the entire prescription, even if you start to feel better. You should never share an antibiotic prescription with another, or use up a left over prescription; even if you think it is for the same complaint. And remember, antibiotics will do nothing for a viral infection, so are unlikely to help if you have a sore throat or a cold!