Antibiotic resistance: a medical threat “as big as terrorism”?

The medicine we take for granted – the antibiotics that have made many formerly lethal illnesses either a minor inconvenience or a thing of the past – is becoming less effective. That’s a huge problem – a “ticking time bomb” that should rank alongside terrorism as threats to the nation, according to Professor Dame Sally Davies, the government’s chief medical officer.

“If we don’t take action, then we may all be back in an almost 19th century environment where infections kill us as a result of routine operations. We won’t be able to do a lot of our cancer treatments or organ transplants.”

What is antibiotic resistance, and is there anything we can do to fight back? Here’s everything you need to know.

What is antibiotic resistance?

In 1928, Alexander Fleming identified penicillin purely by chance. The miracle antibiotic went on to eradicate many of the world’s biggest killers, including tuberculosis.

The problem is, just as larger animals evolve over time and adopt qualities that help them survive in the wild, bacteria become familiar with the antibiotic weapons thrown at them. As a result, infections that were once easily treated with a dose of antibiotics keep adjusting their defences, making them harder to stop.

Why is antibiotic resistance a problem?operating_theatre

Simply put, because every time a bacteria becomes resistant to a strain of antibiotics, we’re one step closer to running out of ideas of how to stop them.

Antibiotics have been developed since the 1930s, but every single class of antibiotic in use today was discovered more than 29 years ago. When bacterial immunity catches up with all of these, diseases once easily treatable may revert to being a death sentence again.

What sort of diseases? Well, The Guardian picked out six back in 2014: Tuberulosis, Gonorrhoea, Typhoid, Syphillis, Diphtheria and Klebsiella. That last one might not be immediately familiar, but it’s arguably the most significant, given it’s the bacteria that causes pneumonia, septicaemia, and meningitis.

Why aren’t there new antibiotics?

Avoiding the obvious answer here – that developing antibiotics is really hard to do – there’s another issue in play: the cost of research and development, set against the drugs’ inevitably short shelf life means that pharmaceutical companies find it hard to justify the money involved.

What kind of costs are we talking? In 2013, Forbes estimated the cost of a developing a new drug at around $5bn. Since every antibiotic we’ve developed to date has eventually met its match, it’s perhaps unsurprising that drug companies fear they won’t make their money back on a drug that could last less than five years before bacteria adapts.

Are there no new antibiotics coming?antibiotic_resistance

Actually, as of 2015, there is a new one on the horizon: teixobactin. It could be available by 2020, and scientists are pretty optimistic about its chances. Firstly, in mice models, teixobactin has proved effective against some of our toughest bacterial infections, including MRSA and TB, both of which had developed immunity to our existing arsenal of antibiotics. Due to its multiple attack methods, scientists believe teixobactin could avoid resistance for 30 years, too.

Secondly, the way in which it was discovered could prompt a revolution in antibiotic research. Due to the constant microscopic battles going on around us, scientists always suspected that there were potentially all kinds of potent new antibiotics waiting to be discovered in the soil, but 99% of these couldn’t be replicated in the laboratory. Scientists from Northeastern University discovered a method for growing microbes in the soil, and then isolating the antibiotic compounds using an electronic chip.

“Apart from the immediate implementation, there is also I think a paradigm shift in our minds because we have been operating on the basis that resistance development is inevitable and that we have to focus on introducing drugs faster than resistance,” Professor Kim Lewis, director of the Antimicrobial Discovery Centre, told The Telegraph.

“Teixobactin shows how we can adopt an alternative strategy and develop compounds to which bacteria are not resistant.”

Is it our fault that antibiotics stop working?straphyloccocus_superbug

Not entirely, but we’re not helping. There are two main reasons for this: one that falls at our feet as doctors’ patients, and the other that’s the farming industry’s responsibility.

Overuse of antibiotics has historically been a real problem. The more the bacteria is exposed to the antibiotic, the greater the chance it will develop a resistance to it. Mild infections that will clear up on their own shouldn’t be treated with antibiotics, but some doctors had felt a pressure to prescribe antibiotics as a surefire way of making their patients feel better.

Then there are patient problems: if you’re on a course of antibiotics, and you feel better, you may forget to – or decide not to – conclude your dose, in the same way you stop taking headache pills when the headache goes away. The problem here is that, if the infection hadn’t been completely wiped out, then undertreated bacteria could develop a resistance.

As for farming, antibiotics have frequently been given to cows, pigs and poultry to compensate for diseases developed through poor conditions and overcrowding. Imprecise dosages of antibiotics, and questionable application is the perfect breeding ground for resistant bacteria, that can then be passed upwards through the food chain or via direct contact.

In November 2015, it was announced that the “emergency antibiotic” colistin had seen bacteria immune to it appearing in pigs.

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Images: Rob Brewer, Angela Sleeping, NIAID, and AndyG used under Creative Commons

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