Download 24.03.15 - irishtimes.com - Second opinion

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Second Opinion: As superbugs get smarter, we cannot be
complacent about antibiotics
Very few new types of antibiotic are being developed, leaving us in danger of antibiotic
extinction
Fidelma Fitzpatrick
Tue, Mar 24, 2015
Now that spring is here, many of us will be out in our gardens, preparing for summer. You
may often have cut yourself while gardening and sometimes these cuts get infected so you
go to your doctor for an antibiotic prescription. Most of us presume that the antibiotics will do
their job and we can get back to the garden that week.
However, 100 years ago, before antibiotics were discovered, skin infection as a result of
simple cuts frequently killed people, as did common infections such as pneumonia or
tuberculosis. It is sobering to remember how much antibiotics have revolutionised medical
practice in the past 75 years and saved millions of lives since their discovery. Early
descriptions of the use of penicillin in the 1940s are dramatic: common infections that used
to kill people could be treated for the first time. Antibiotics were quickly recognised as
miracle drugs, and the possibilities they offered seemed endless. In the 30 years after the
discovery of penicillin, new antibiotics were rapidly developed but, because antibiotic
resistance was little understood, “superbugs” were yet to be described, and the pipeline of
new antibiotics seemed endless, there was no attempt to use these agents wisely.
This was the era when it was thought that antibiotics were a limitless resource and, as soon
as resistance to one antibiotic emerged, the pharmaceutical industry produced newer, more
effective antibiotics. By preventing and/or treating infections, antibiotics also facilitated many
of the advances in medical practice that we now take for granted, such as orthopaedic
surgery, chemotherapy and organ transplantation.
Antibiotics are prescribed very commonly: for example, to one in three hospital patients and
one in 10 long-term care residents in Ireland. We consume more antibiotics than our
Scandinavian neighbours, though fewer than the Mediterranean countries. In parallel, our
antibiotic resistance rates are higher than Scandinavia though lower than the Mediterranean.
We have got so used to antibiotics saving lives that it is difficult to remember a time when we
did not have them. However, we can no longer be complacent. Because of increasing
reports of antibiotic resistance (the “superbugs”), we may be returning to a time where
simple infections are no longer treatable with antibiotics.
Antibiotics are very specific medications designed to work on infections caused by bacteria
(for example, skin or kidney infections) and do not work on infections caused by other agents
such as viruses (for example, the common cold or flu) or fungi (for example, those that can
cause thrush).
Antibiotic resistance is a fact of life. Bacteria have existed for billions of years and are very
adept at survival. They can figure out rapidly how to protect themselves against antibiotics
that are designed to kill them, particularly in situations where antibiotics are overused or if
not taken exactly as prescribed. This is called antimicrobial resistance (AMR).
Using antibiotics when they are not needed, or not taking an antibiotic course exactly as
prescribed, gives bacteria a chance to get used to the antibiotics and to adapt so that the
bacteria can’t be killed any more.
These antibiotic-resistant superbugs can then go on to cause serious illness and perhaps
death. Many different superbugs have been discovered and include methicillinresistantStaphylococcus (MRSA) and carbapenem-resistant Enterobacteriaceae (CRE).
While antibiotic use and antibiotic resistance continues to increase, very few new types of
antibiotic are now being developed, which means that we run the danger of antibiotic
extinction, so we must make sure that the ones we have remain effective against infections
for the sake of future generations. Though the threat of a return to the pre-antibiotic era may
appear alarmist, it has been predicted that if antibiotic resistance continues to rise at current
rates, by 2050 antibiotic resistance would cost US$100 trillion (€94.3 trillion); 10 million more
people would die every year than if resistance rates remained at current level; and gross
domestic product would reduce by between 2 per cent and 3.5 per cent.
However, these studies do not take into account the dramatic social and healthcare costs of
antibiotic resistance. If somebody develops an infection that antibiotics cannot kill because it
has built up resistance to the treatment, then that person will become very unwell and may
die. This person could have been cured if the infection had not become resistant to
antibiotics.
Most people who undergo surgery receive antibiotics to prevent postoperative infection, but
without effective antibiotics, surgery that is now routine will become much more risky.
Cancer patients receive chemotherapy treatments and transplant patients take antirejection
medications that weaken their immune systems, making them much more vulnerable to
infections. Without effective antibiotics to prevent and treat infections, chemotherapy and
transplantation would be incredibly risky and potentially impossible.
So what can be done? Clearly national and international policymakers have a role, but
everybody can play a part in minimising the emergence and spread of antibiotic resistance:
Firstly, you can reduce your risk of infection by living a healthy lifestyle with a good diet and
exercise, getting vaccinations to prevent infectious diseases if indicated and integrating good
hygienic practices (for example, food hygiene) as part of your daily routine. If you do develop
an infection, practise good hygiene: use a tissue to cover your mouth when you sneeze or
cough, and wash your hands afterwards.
Don’t assume you need an antibiotic from your GP: if it is a viral illness, rest and time may
be the solution.
Use antibiotics wisely: if you are prescribed one, take it exactly as prescribed and finish the
course. Don’t save antibiotics for later and don’t share them with others.
The website undertheweather.ie gives sensible practical information on a range of common
conditions such as colds, flu, earaches, sore throats and tummy bugs. It tells you how long
they should last, what to expect, and what you can do to cope with, and recover from, these
illnesses. The site includes a series of videos featuring GPs and pharmacists who offer their
expertise on dealing with these common illnesses, practical remedies, and advice on when
to seek medical help.
Dr Fidelma Fitzpatrick is a senior lecturer at the Royal College of Surgeons in Ireland(RCSI)
and consultant microbiologist at Beaumont Hospital in Dublin. Dr Fitzpatrick and Dr Nuala
O’Connell of the Irish College of General Practitioners will discuss the topic of superbugs
and antibiotic resistance at the RCSI MiniMed lecture tomorrow from 7-9pm at RCSI, 123 St
Stephen’s Green, Dublin 2. To register for this free event, see rcsi.ie/minimed. You can join
the conversation on Twitter at #RCSIMiniMed