In newspapers dominated with Donald Trump and the rise of right ring politics we tend to ignore the very immediate and perhaps equally insidious prospect presented by a future without antibiotics. Last week was World Antibiotic Awareness Week. Were you aware of it?
Bacterial resistance to antibiotics is a very real problem. Imagine reverting back to a time where a bad cut could kill. An awful future where surgeries as common place as a hip replacement could prove fatal and chemotherapy or organ transplants could not even be contemplated.
The war against bacteria
Antimicrobials are probably one of the most successful chemical therapies in the history of medicine. Think how many lives have been saved since the first antibiotic, Penicillin, became available in the 1940s. They have been heralded as miracle drugs and a staple weapon in any doctor’s armoury.
Put simply antibiotics kill bacteria. Bacteria only, not viruses or fungal infections. For decades bacteria would evolve and many new antibiotics were created in response in the 1940’s, 1950’s and 1960’s. E.Coli remained troublesome until a new, sophisticated antibiotic class, the carbapenems, was discovered in the 1980’s. We were winning the war.
So resistance is not a problem as long as new drugs to fight resistant bacteria keep being churned out. However would it shock you if I told you the last new class of antibiotic to be developed was in 1987? Almost thirty years ago!
Bacteria love to reproduce and do so at an alarming rate. Their indiscriminate a-sexual behaviour means that they are constantly evolving and building defences to antibiotics by swapping traits.
In recent times the penicillin and cephalosporin resistant super bug, MRSA (Methicillin-resistant Staphylococcus aureus) has ran rampant in our hospitals. It was discovered somewhat belatedly that good hygiene was the only real answer to combat most strains. More worrying is the emergence of New Dehli Metallo-beta-lactamase-1 (NDM-1) which is resistant to carbapenems, our answer to E.Coli in the 1980’s.
An inconvenient truth
A world where antibiotics are useless against bacteria is looming closer and closer and the sad truth is that we are completely to blame. The profligate use of antibiotics to treat minor illnesses that the immune system would fight itself has played a massive role in the rise of resistance. Pandering to demand has meant that antibiotics are being prescribed wrongly and courses are not being adhered to by patients for sufficient durations. Worse still antibiotics are now sold without prescription in many countries and as a result the problem of resistance is escalating.
The feeding of antibiotics in large quantities to livestock in order to promote growth is another major cause of resistance. Although this practice is banned in the E.U it is common in other parts of the world especially in the United States. As the human population eats this produce we are being exposed to more and more of these drug-resistant strains.
New antibiotic arsenal
Pharmaceutical companies tend to invest their billions in order to develop novel treatments for diseases that will pay back hopefully three or fourfold. The incentives are not there for drug companies to invest money in developing new classes of antibiotics because they are relatively low-profit and may only prove relevant for mere weeks before the bacteria become resistant.
Is a future without antibiotics inevitable?
Not necessarily, but we need fast action. Antibiotic consumption is falling in many European countries but rising in Ireland. We need new laws to make it illegal globally to sell antibiotics over-the-counter. We also need to dissuade people from their over-reliance on antibiotics. Could we implement economic measures such as a tax on antibiotics use to solve this issue? Unpopular maybe, but perhaps then this income could be used to fund new research.
The future is not set in stone but if we fail to grasp the impact our actions are having today we may have wasted one of the greatest discoveries to be made in human health.