Monday, 08 October 2018 11:31

Antibiotic Resistance Featured

When antibiotics were first discovered and used in the 1940’s they were quite rightly regarded as miracle drugs. They allowed many simple but potentially fatal infections such as pneumonia to be cured. Their use together with immunisations, contraception and public health measures has done more for alleviating human suffering and prolonging life than anything to date.

Almost all of the classes of antibiotics we use today were developed between 1940 and 1962. However, at present there are very few novel antibiotics under development.  Unfortunately at the same time there is increasing bacterial resistance to all our known antibiotics. Without improved use of our existing antibiotics and further development of new ones we face the prospect of one day returning to even simple infections posing a serious risk. This will be particularly a problem for the very young and the old.

How Do Antibiotics Work?

 Antibiotics work to help our bodies to fight only bacterial infections. They do not help with infections caused by viruses such as the common cold, influenza, cold sores, HIV and viral hepatitis.  Bacteria can infect any organ in the body and common infections include pneumonia, tonsillitis, wound infections, impetigo (school sores) and some forms of gastroenteritis.

Antibiotics work by interfering with processes within the bacteria to either damage them or to stop them growing. This then gives our immune system time to deal with the infection before it overtakes the body.

Why Do Bacteria Become Resistant?

Bacteria grow and divide all the time. They contain their own genetic material that is passed on to the next generation. Sometimes a bacterial cell may genetically mutate and the new type of gene it displays gives it the ability to protect itself from the effects of a particular antibiotic. This means it will be able to keep growing and replicating itself despite the use of an antibiotic. It is then said to be resistant to that antibiotic and if passed on to another person they may not be able to be successfully treated with that antibiotic.

Bacteria are more likely to become resistant the more they are exposed to antibiotics. Also non-pathogenic (harmless) bacteria in our bodies can also develop a resistance to the antibiotic and can sometimes pass on this resistance to other more dangerous bacteria should they enter our body. For this reason doctors should only use antibiotics when really necessary and when they do they should try to use the most appropriate one for the infection.

Why Do We Have a Problem?

 Unfortunately antibiotics have been overused or not used appropriately for decades. This has been a worldwide problem and is not just restricted to use in humans. The overuse of antibiotics in animals has also played a major part.

In medicine antibiotics have been used to treat infections like the common cold or influenza and, being viral in nature, were never going to work. In some countries antibiotics can be obtained without a medical assessment. In addition there is considerable patient demand for the use of antibiotics for infections where we know they will be ineffective. Sometimes there is diagnostic uncertainty about whether an infection is present or is bacterial or viral in nature. Increasing patient expectations and medico-legal risk sometimes can compel doctors to prescribe “just in case”.

Due to all of these factors, over the last 20 years or so we have seen the emergence of so called “super bugs” that have grown resistant to all the usual antibiotics used to treat them. This has particularly been a problem within hospitals but now more and more we see cases of infections in the community from these multi-resistant bacteria. A well known one has been a bacterium commonly known as “Golden Staph” but more correctly called Methicillin Resistant Staph Aureus (MRSA). It can cause a variety of infections but is particularly difficult to treat if it infects artificial joints.

What Can We Do?

As health consumers there are a number of things we can each do to reduce the unnecessary use of antibiotics.

  1. Be aware that antibiotics will not help with simple respiratory infections like a cold or flu including those with symptoms such as a sore throat or cough. Yellow snot does not signify a need for antibiotics.
  2. Act in partnership with your doctor to avoid antibiotic use unless strictly necessary.
  3. When prescribed antibiotics, take them as prescribed and finish the course.
  4. Don’t take antibiotics prescribed for others or left over ones you have from a past infection. See your doctor first.
  5. Good hygiene practices such as hand washing can reduce the spread of infections.

The medical profession also needs to lift its game and reduce the unnecessary use of antibiotics. This comes through better education, more resources to support antibiotic decision-making and a commitment to achieve better prescribing outcomes. Also stricter attention to hygiene principles such as hand washing will reduce infection rates acquired within health facilities.

Governments around the world also have a role to play. They should restrict all antibiotic prescribing to qualified health professionals. In addition they will need to insist on and support better governance of antibiotic prescribing in their health systems. In addition they should also insist upon closer supervision of the use of antibiotics in animal husbandry and veterinary practice.

We are now at a critical point where without making these necessary changes we will fast find ourselves in the terrible situation of people dying of diseases that were easy to treat only a few short years ago.

We cannot hope for a technological advance alone to solve this problem, as there is currently no major breakthrough anywhere in the pipeline. It will take willingness and cooperation at all levels of our society and needs to start with individual behaviour.