If there’s one area of medicine we’ve perhaps come to take for granted in the past 50 years, it’s antibiotics.
Ear infections, throat infections, STIs: bacterial infections are wide-ranging, common, can affect just about any part of the body and can, when left untreated, cause serious harm.
However, due to the ready availability of antibiotics, these sorts of infections are generally regarded as little more than a nuisance in the developed world. Many patients see them as easily solvable, with a trip to the GP and a one- or two-week course of tablets.
For this reason, the growing problem of antibiotic resistance is a vastly underestimated one.
As part of Ask Your Pharmacist Week, and with European Antibiotic Awareness Day just around the corner, we thought this would be a pertinent subject to discuss with Consultant Pharmacist David Kelly.
Just how big is this problem?
When you consider how integral a fixture antibiotics are in our healthcare system, the issue is a huge one, as David explains:
‘The problem of antibiotic resistance affects everyone. We are all at risk of developing an infection. Prior to the 1930s, before antibiotics were discovered, infections that we now regard as trivial were often fatal.’
What’s more, this type of medicine plays an important role in rehabilitative care.
‘Modern medicine depends on the use of effective antibiotics. Many of our complex surgical procedures such as heart or bone surgery would not be possible without them and neither would many cancer treatments.’
Not everyone will have experienced antibiotic resistance first hand, but it is a phenomenon healthcare professionals are encountering on an increasing basis:
‘We are seeing increased resistance to both serious life threatening infections in hospital such as TB and and also common community infections like cystitis and pneumonia and gonorrhoea.'
'Patients with infections caused by drug-resistant bacteria are generally at increased risk of health complications and need to use the healthcare system much more than patients with infections caused by non-drug resistant bacteria.’
What is causing it?
It’s biologically inevitable that an organism will evolve and mutate to survive. Consequently, when a new antibiotic is developed, it will only be effective for a finite period, before the type of bacteria it targets becomes immune to it, as David illustrates:
‘Bacteria and other microbes will tend to naturally develop a resistance towards any drug we use against them.’
As David goes on to explain, this issue has been exacerbated to an extent, by the way we use antibiotics:
‘The natural tendency of bacteria and other microbes to develop resistance is ‘encouraged’ by inappropriate use and prescribing of antibiotics.
Inappropriate prescribing includes:
- giving antibiotics when they are not really necessary
- selecting the wrong type of antibiotic and giving the wrong dose
- or issuing it for the incorrect duration
Whereas inappropriate use includes:
- requesting an antibiotic when one is not necessary
- skipping doses or not completing the course
- saving some for later
- or sharing antibiotics with others.’
Limiting the effects of antibiotic resistance then, as evidenced above, is not a responsibility exclusive to healthcare practitioners. The patient taking the drug has a role to play as well.
David stresses the importance of the following for patients, when going about treating an infection:
- ‘Sometimes antibiotics aren’t necessary, so it’s helpful not to demand them; many infections will clear of their own accord. Ask a pharmacist how to treat your symptoms.’
- ‘Take any prescribed antibiotics exactly as prescribed. Do not save any for later and do not share them with anyone else.’
- ‘Never take antibiotics unless they have been prescribed by a healthcare professional.’
What is being done?
The discovery of new antibiotics has significantly slowed since the 1970s, which naturally leads one to question: what is the healthcare industry doing to address this problem?
‘Several of the global pharmaceutical companies do have active antibiotic development programs but finding new antibiotics is now more scientifically challenging than it was in the 1970s and 1980s. It is simply more complex and time consuming to develop new lead agents.’
In addition to the increasing complexities of the required science, money and the fundamental nature of business are crucial determining factors too:
‘The increased scientific challenges of developing new antibiotics has a big financial impact and a drug company can only invest time and resources into developing new medicines if there will be a financial return.'
'Antibiotics are an inherently low-return product; they are only taken for short amounts of time compared with, for example, a medicine for high blood pressure which is taken long term.’
Pharmacy and doctor practice
Until progress is made, David explains, point of care attitudes to antibiotic treatment need to change:
‘All healthcare professionals should be changing their practice to address the problem. Responsible prescribing and patient education are key.’
‘Healthcare organisations monitor antibiotic prescribing and provide support to healthcare professionals in changing the way they prescribe antibiotics. Useful resources for both patients and healthcare professionals can be found on the UK government website and at NHS choices.’