In 2014 the World Health Organization declared antibiotic resistance as one of the greatest public health crises of modern time. Hannah and TheDoctorService.co.uk explores antibiotic resistance and what this means for you…Since the accidental discovery of the first antibiotic by Alexander Fleming in 1928 at St Mary’s Hospital in London, antibiotics have revolutionised medicine and prevented millions of deaths worldwide.
What are antibiotics?
Antibiotics are defined as a drug that kills or inhibits the growth of bacteria.Antibiotics are effective against bacterial infections such as urinary tract infections, pneumonia and strep throat. In addition, antibiotics are used during cancer treatment, organ transplants and even used to keep animals healthy. Despite their broad range of use, antibiotics are ineffective against viral infections such as the common cold and flu.
Antibiotics have become fundamental in medical practice with around one in three individuals in the UK taking at least one course of antibiotics per year.
What is antibiotic resistance?
Antibiotic resistance occurs when an antibiotic loses its ability to inhibit the growth of, or kill bacteria. The DNA in bacteria naturally mutates over time and these mutations can sometimes cause the bacteria to become resistant to an antibiotic it previously was susceptible to. These bacteria with the advantageous antibiotic resistant mutation are more likely to survive, reproduce and can even pass on the resistant mutation to other bacteria. Infections caused by antibiotic resistant bacteria are often difficult to treat and can cause an increase in mortality, length of hospital stay and cost of treatment.
Although mutations causing antibiotic resistance are a natural phenomenon, antibiotic resistance is being encouraged by a plethora of factors and behaviours which include the prescribing habits of health professionals as well as use of antibiotics in the food and agriculture industry.
Around 80-90% of antibiotics used in medicine are prescribed by GPs in the UK. Patients are sometimes unnecessarily prescribed antibiotics to treat common illnesses such as sore throats and ear infections but it is often difficult to distinguish between viral and bacterial infections and infections do not always require antibiotics and may clear on their own.
Antibiotics can cause more harm than good when prescribed incorrectly and do not discriminate between ‘good’ and ‘bad’ bacteria in the body. (We need lots of good bacteria to protect us and for our survival!).
Exposing ‘good’ bacteria to antibiotics can contribute to antibiotic resistance in these bacteria too which may lead to problems as the good bacteria can go on to share their resistant genes with dangerous bacteria. In addition, by killing the beneficial bacteria in our body, this can give an opportunity for more dangerous, disease-causing bacteria to grow in their place.
Antibiotics also have a number of side effects including vomiting, thrush and diarrhoea so therefore should only be prescribed when needed.
Often patients want relief from symptoms and believe that antibiotics will be able to do this and therefore pressurise their doctor into prescribing antibiotics. One study showed that an antibiotic prescription made patients feel as if they had not wasted the doctor’s time or their own as well as validate the fact that they have an illness.
This can put health professionals in a difficult position causing them to prescribe antibiotics even if they know that the antibiotics will be ineffective.
There are some complex behavioural reasons behind overprescribing of antibiotics and the public and patients should be aware of the limitations of antibiotics as well as the dangers of overprescribing.
Inappropriate use of antibiotics by patients
If you ever have been prescribed antibiotics I am sure you remember the doctor reminding you to take the entire course of antibiotics even if you start to feel better, not to share antibiotics and not to skip doses. Given our busy lives this is often easier said than done. It is important not to share or miss doses however very recently a group of doctors and public health specialists in the UK have suggested that very little research actually supports the idea that failure to complete a course of antibiotics contributes to increased antibiotic resistance. They have also suggested that it may be safer to stop taking your course of antibiotics once you start to feel better to reduce over-treatment. Currently more research is required and The Doctor Service recommends that you follow your doctor’s guidance on taking antibiotics.
Use of Antibiotics in farming
Antibiotic use extends beyond humans and routinely used in farms across the world and for decades antibiotics were used in the UK to promote the growth of livestock, but this was banned in 2006 in the EU including the UK. Nowadays antibiotics are only used to control and treat diseases in animals and livestock and to do this healthy animals are given antibiotics to prevent outbreaks of diseases in large, crowded intensive farms.
The evidence suggests that there is very little risk of the antibiotics themselves being present in the food that humans eat. However antibiotic resistant bacteria can spread between animals and humans either through the environment or through the food that we eat.
Bacteria in Supermarkets
Alarmingly one study carried out in 2014 in seven supermarkets across the UK found that 24% of poultry contained E-coli bacteria that was resistant to major antibiotics. Although the numbers seem scary this does not mean that it is necessarily dangerous to eat meat. The Doctor Service recommends that you ensure that all meat you consume is cooked completely and try and source meat from free range farms, where animals are less likely to be exposed to antibiotics.
What is the impact so far of antibiotic resistance?
It is estimated that annually there are 700,000 deaths caused by drug resistant pathogens. The UK report commissioned by the UK government stated that if nothing is done about antibiotic resistance this figure could rise to 10 million deaths by 2050.
Can’t we just make new antibiotics?
In the 80’s and 90’s it seemed that every few years a new antibiotic was being released into the market, ready for use in hospitals and GP surgeries. Although it is true that scientists need to be more innovative and creative in identifying new antibiotics, the pharmaceutical industry in the past has not invested greatly in antibiotic research.
Pharmaceutical companies are based on maximising profit, and developing new antibiotics is a costly and lengthy process which does not guarantee a huge return in profits in comparison to long term therapies for chronic diseases. However as the dangers of antibiotic resistance grows, governments across the world are increasingly trying to incentivise antibiotic research, and in the UK, government plans to invest £50 million to set up a global fund for Anti-Microbial Resistance research.
If new antibiotics are identified it can still take up to 20 years before they can be added to the market and used in clinics and hospitals.
So what else is being done about it?
The UK government has realised the enormity of the antibiotic resistance crisis and has increased funds and resources for health professionals and the public to tackle the crisis. We all have a role to play to tackle the rising rates of resistance and government plans includes working with a range of health professionals from GP’s to pharmacists as well as targeting schools and universities to raise awareness and promote good hygiene to stop the spread of diseases.
What can you do?
- Be aware that antibiotics cannot be used to treat viral infections such as colds and flu. Try not to pressurise your doctor into giving you antibiotics unless a bacterial infection is obvious or has been confirmed.
- Ensure that you finish your course of antibiotics, do not skip doses or share your antibiotics.
- Do not take antibiotics unless they have been prescribed to you. Do not buy antibiotics from websites not regulated by the MHRA (Medicines and Healthcare Products Regulatory Authority)
- Become an Antibiotic Guardian. Make a pledge about how you will make better use of antibiotics and help tackle the rising danger of antibiotic resistance. Tell your friends, family and colleagues and join the fight against antibiotic resistance. The Doctor Service has also pledged to be antibiotic guardian. Sign up here: http://antibioticguardian.com
The battle against antibiotic resistance is a long and difficult one. It is important to understand that you as a patient can be part of the fight to ensure that we don’t use up our finite resource of antibiotics to protect not only our health but the health of future generations.
Get further information on antibiotic resistance here:
World Health Organization: http://www.who.int/antimicrobial-resistance/en/
Antibiotic Guardian: www.AntibioticGuardian.com
Watch Michael Mosley discuss antibiotic resistance in Michael Mosley vs the Superbugs here: http://bit.ly/MichaelMosleySuperbugs
Edited by Dr Kiran Sodha & The Doctor Service
- Tackling drug-resistant infections globally: final report and recommendations, The review on antimicrobial resistance, Jim O’Neill, May 2016, https://amrreview.org/sites/default/files/160525_Final%20paper_with%20cover.pdf , accessed on 29th August, 2017.
- One in four supermarket chicken samples contain antibiotic resistant E. Coli, Nadia Khomani and agency, 5th September 2016, https://www.theguardian.com/world/2016/sep/05/antibioticresistant-e-coli-uk-supermarket-chicken-samples-contain, accessed on 27th August, 2017
- Health matters: antimicrobial resistance, Public Health England, https://www.gov.uk/government/publications/health-matters-antimicrobial-resistance/health-matters-antimicrobial-resistance, accessed 27th August 2017
- Antibiotic resistance poorly communicated and widely misunderstood by UK public, The Wellcome Trust, 29th July 2015, https://wellcome.ac.uk/press-release/antibiotic-resistance-poorly-communicated-and-widely-misunderstood-uk-public, accessed on 27th August 2017
- Llewelyn, Martin J., et al. “The antibiotic course has had its day.” Bmj 358 (2017): j3418.
- Antibiotic Resistance and the Responsible use of Antibiotics in Farm Animals, Responsible Use of Medicines in Agriculture Alliance, http://www.ruma.org.uk/wp-content/uploads/2014/04/RUMA-ANTIBIOTIC-RESISTANCE-INFORMATION-NOTE.pdf, accessed on 28th August 2017
- Government response to Review on Antimicrobial Resistance, AMR policy team, September 2016, https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/553471/Gov_response_AMR_Review.pdf, accessed August 29th 2017
- GPs feel pressurised to prescribe unnecessary antibiotics, survey finds, Andrew Cole, August 2014, http://www.bmj.com/content/349/bmj.g5238, accessed 28th August 2017