Antibiotic resistance is a growing concern among medical professionals.
We all take it for granted that a short course of antibiotics will sort out a persistent bacterial illness, such as a bout of severe cystitis or a bad chest infection.
But now there’s worrying evidence that some of the most commonly used antibiotics are no longer effective against certain bacteria. In Europe, reports say twice as many people die from hospital-acquired infections caused by antibiotic-resistant bugs than from road accidents.
Dr Hayley Wickens, a pharmacist with a research interest in antimicrobial resistance, gave us some insight into what’s causing the problem and how we can all better protect ourselves.
Why aren’t antibiotics working in some cases?
Since the introduction of the first antibiotics in the ’30s, we’ve been in an evolutionary arms race with bacteria. We produce a new antibiotic, they develop resistance; we produce another one, they develop resistance to that, too.
All antibiotic use drives antibiotic resistance. This is why it’s so important that we only use antibiotics when we absolutely need to, as inappropriate use may increasingly cause patients to be colonised or infected with the resistant types of bacteria.
Antibiotics have been prescribed for cold and flu infections in the past, despite the fact these illnesses are caused by viruses and not bacteria, and in some countries, antibiotics can be bought without prescription over the counter.
Why is it such a worry now?
Globally, we have hardly any new antibiotic drugs in the pipeline. There have been no new antibiotic classes discovered since 1987, and drug companies haven’t been investing in antibiotic research. We’re just not keeping ahead and are fast running out of treatment options.
What’s happening in the world at the moment?
Some bacteria are starting to produce enzymes that stop the most commonly used antibiotics in hospitals – penicillins and cephalosporins – from working. Called ESBLs, these enzymes are commonly produced by Klebsiella bacteria, which cause urinary tract infections (UTIs) and lung infections in hospital, and E.coli bacteria, which can also cause UTIs. There are now few drugs left that work against them; as a result, we frequently have to use drugs called carbapenems that are given to patients intravenously.
Are some people more likely to get these bugs?
People who are very sick and in hospital for serious conditions, or who have a weakened immune system after having a transplant or cancer treatment, are at greater risk of developing all types of infection, including those caused by antibiotic-resistant organisms. The difference is that it’s more difficult to treat drug-resistant-bacteria infections.
How likely am I to get one if I have to go into hospital for a procedure or operation?
ESBL infections are, thankfully, still rare. Of all E.coli cases in hospitals, less than one in six was caused by an ESBL strain. Hygiene vigilance can decrease your chances of infection – the UK has seen a 40% drop in superbug infections because of a hand-washing campaign in hospitals.
How can these bugs be treated?
For some resistant bacteria, the only antibiotics that will work have to be given by IV drip. These include broad-spectrum carbapenems, such as meropenem and ertapenem.
Interesting new research
Current NHS advice states that it is “essential to finish taking prescribed course of antibiotics, even if you feel better”. They do stipulate that if a healthcare professional tells you otherwise, you can stop taking the medication, but generally advice is overwhelmingly in favour of finishing it until the end.
The NHS warn that “If you stop taking an antibiotic part way through a course, the bacteria can become resistant to the antibiotic.”
Yet in a new article posted in the British Medical Journal, 10 experts are calling for this advice to be dropped. The lead author of the article Martin Llewelyn said: “With little evidence that failing to complete a prescribed antibiotic course contributes to antibiotic resistance, it’s time for policy makers, educators, and doctors to drop this message.”
Speaking to the Telegraph chief medical officer Dame Sally Davies said the public should not change their actions until further research is conducted.
She says, “The Department of Health will continue to review the evidence on prescribing and drug resistant infections, as we aim to continue the great progress we have made at home and abroad on this issue.”