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Contents
What are antibiotics?
3
How do antibiotics work?
4
How do bacteria become resistant?
4
Antibiotics and MRSA
5
How can we slow down resistance?
7
What about antibiotics in the
environment?
9
How is resistance being tackled
worldwide?
10
How to find out more
12
2
What are antibiotics?
Antibiotics were a medical miracle when
they were first manufactured in the 1940s.
Within four years however the first resistant
bacteria had begun to appear. Since then,
the pharmaceutical industry has continued
to develop new products and stay one step
ahead. However, there are real concerns
that ultimately we could have no effective
antibiotics left.
This spread of resistance has been due to a
combination of factors, including:
•wide prescribing of antibiotics, sometimes when they are not needed
•international travel, making it easier for resistant bacteria to spread
• the re-emergence of ‘old’ diseases (such as TB), especially in inner cities
• the use of antibiotics in farming and agriculture
•poor hygiene leading to the spread
of infections.
3
How do antibiotics work?
Bacteria are tiny single-celled organisms.
Viruses are even tinier, and are not really
organisms but infectious particles which can
only reproduce by using the DNA of the cell
they have infected.
Antibiotics act against bacteria. Because
they cannot attack viruses, they are
ineffective against common viral infections
like cold and flu.
Antibiotics attack bacteria in different ways.
For example, an antibiotic like penicillin
will attach itself to the cell wall of a single
bacterium and rupture it, so destroying the
bacterium. Other types of antibiotic work by
interfering with the metabolism of bacteria.
How do bacteria
become resistant?
If bacteria have mutated their DNA - or have
acquired new DNA - their cell wall will be
altered. This means that the antibiotic can’t
attach to the cell wall and destroy it. Those
bacteria have then become resistant to that
antibiotic. They will then multiply to create
many more resistant bacteria.
4
Bacteria which survive attack by an antibiotic
will be those which have this resistance. This
is why it’s so important to finish a course of
antibiotics, so that there is less likelihood of
resistant bacteria surviving and multiplying.
An unlucky patient may either have resistant
bacteria to begin with, or their bacteria may
become resistant during treatment.
Resistance can spread in two ways:
•by resistant bacteria multiplying
•by bacteria exchanging DNA material with other bacteria.
Resistance is a natural and inevitable
phenomenon, but we can slow it down so
that antibiotics remain useful for as long as
possible.
Antibiotics and MRSA
We are hearing much in the news about
MRSA - the so-called superbug Methicillin
Resistant Staphylococcus Aureus.
The UK has one of the highest MRSA rates in
the world. The health consequences for the
population, while often overstated, probably
translate into several hundred deaths a year
and a lot of suffering and anxiety.
5
Antibiotics have been a major success story.
Yet without antibiotics there would be no
MRSA. Frequent and excessive antibiotic
prescribing both in our hospitals and in the
community have helped MRSA to evolve
over the past four decades into a superbly
adapted bug, continually changing into new
virulent mutants, and resistant to more and
more antibiotics.
People are now carrying this bug within the
community, and can bring it into hospitals,
either as patients, staff or visitors. In
hospitals it is easily spread to other patients,
many of whom may be very vulnerable to
such an infection.
Hospitals are working hard to prevent
MRSA infections through a wide range
of procedures. Visitors also have a
responsibility to ensure they:
•wash their hands
•avoid introducing any possible infections to patients
•don’t sit on beds.
6
How can we slow
down resistance?
We can help prevent bacteria developing
resistance by:
…preventing infections
•good personal hygiene especially handwashing, but not using antibacterial products which could themselves promote resistance.
•finding out how to prepare and cook food safely, and keeping surfaces and work areas clean (not using antibacterial products).
•taking advantage of immunisation programmes.
•good hygiene and infection control procedures in hospitals, where antibiotic use is naturally heavy, and there are patients with weakened immune systems who are vulnerable to infections.
…good prescribing
•doctors taking a sample from the patient to test in the laboratory. This will confirm if the infection is being caused by bacteria, and will guide the doctor in choosing the best treatment. This service is called ABLE (Accelerated Bacteriology Laboratory Evaluation). It is available to most GPs. You might want to ask your doctor about this.
7
•guiding and encouraging doctors to prescribe narrow-spectrum, specific antibiotics.
•encouraging patients not to pressurise their doctor to prescribe an antibiotic for a viral infection simply because they think it will help them get back to work sooner - it won’t!
..taking antibiotics properly
If you are prescribed antibiotics:
DO
•discuss with your doctor why and how these are being prescribed
•report any allergies, or other medication you are taking
•follow your doctor’s guidance on how many days you should take the antibiotic, even if you feel better quite quickly
•take them at the same time every day
•follow the instructions on the label, remembering to observe the advice on whether or not they should be taken with food
•remember your community pharmacist will also be able to advise you.
8
DON’T
•forget to take them
•share your prescription with other people, or save some for ‘next time’
•ignore unexpected side effects.
What about antibiotics
in the environment?
When antibiotics are used in humans and
animals, 80-90% passes through the body
without being broken down. This enters
the environment through the waste system,
where it can affect naturally-occurring
bacteria and encourage them to become
resistant.
In the past, farmers in some countries fed
antibiotics to healthy farm animals to help
them to gain weight. When this happens,
bacteria in the animal can become resistant,
and can be passed to people through eating
the meat if it is not properly cooked. These
bacteria can then interact with normal
bacteria in the person’s stomach and gut and
can cause resistance to develop.
The European Union prohibits the feeding
of any antibiotic feed to animals which are
destined to be eaten by humans.
9
How is resistance being
tackled worldwide?
Resistance is a worldwide problem, as
resistant bacteria can travel across the world
by plane, water, wind, or on a human or
animal host.
While infections are less common than they
used to be in the UK, more people are on
medication which affects their immune
system and makes them prone to infections.
The World Health Organisation (WHO)
monitors bacterial resistance worldwide
and has a global strategy for prevention.
This includes improving public health
measures such as water and sewage
systems in developing countries, and better
immunisation programmes. Unfortunately
progress can sometimes be hampered by
local economic hardship and wars.
In the UK, availability of antibiotics is restricted
by law. This means that they are more likely
to be used appropriately. In some countries
however, antibiotics are available overthe-counter for anyone to buy without a
prescription.
10
Recently, people have been able to obtain
antibiotics, like many other medicines, freely
over the internet without a prescription.
These antibiotics are often counterfeit and of
very poor quality.
Please remember that our UK
restrictions are in your interest, and do
not be tempted to self-medicate with
antibiotics. Always seek professional
advice from your doctor, nurse or
pharmacist.
Governments, researchers, hospitals, doctors,
pharmacists, and every individual patient
and member of the public has a role to
play in helping to preserve antibiotics as
the powerful - and in some cases life-saving
- drugs that they currently are.
11
How to find out more
To find out more about antibiotics, and how
you can help relieve the symptoms of minor
ailments:
•ask your GP, or the nurses based at your practice
•talk to your local pharmacist (chemist)
•call the free NHS Grampian healthline on 0500 20 20 30
To find out more about NHS Grampian visit:
www.nhsgrampian.org
You may also find the following
websites of interest:
www.food.gov.uk
www.fda.gov
(The US Food and Drug Administration)
www.cdc.gov
(The US Center for Disease Control)
www.tufts.edu/med/apua
(Alliance for Prudent Use of Antibiotics)
This publication is also available in large
print and on computer disk. Other formats
and languages can be supplied on request.
Please call Equality and Diversity on (01224)
551116 or 552245 or email [email protected]
Ask for publication CGD 100094
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