Living in a post-antibiotic era: the impact on public health

Most of us have taken antibiotics at some point in our lives. The majority of the time, we take a 3-5 day course for a minor illness like a chest infection. If you’re unfortunate enough to get something more serious, you might have a course that lasts several months. If you’ve ever had cancer treatments or surgery of any kind, antibiotics will be on hand to ensure you survive the treatment. These “magic bullets” have revolutionised medicine and many of us would not be here without them.

Unfortunately, all good things must come to an end. We have misused antibiotics and now many of them have lost their effectiveness. Some diseases, like MRSA and multidrug-resistant gonorrhoea cannot be treated with most, if not all antibiotics. This problem will increase over the coming years and soon we won’t have any antibiotics left to use. Ever since they were discovered, the threat of resistance has been strong.

“The time may come when penicillin can be bought by anyone in the shops. Then there is the danger that the ignorant man may easily underdose himself and by exposing his microbes to nonlethal quantities of the drug make them resistant.”

(Alexander Fleming, Nobel Prize speech 1945).

We are facing an antibiotic crisis. What does the future hold for our health without this medicine?

As part of our public engagement programs, the Biochemical Society and the Society for General Microbiology held a public lecture and debate on 19 November 2014 at Hills Road School, Cambridge. This event was held the day after European Antibiotic Awareness Day.

“We take antibiotics for granted”

Paul introduces antibiotic resistance
Paul introduces antibiotic resistance

To begin, Chair Paul Hoskisson (University of Strathclyde), introduced the topic. He showed us the Scottish £5 note, which features an image of Alexander Fleming. He reminded us that we take antibiotics for granted so much, that we have a picture of the man who discovered penicillin on the lowest note denomination.

He discussed how antibiotic resistance is an evolutionary biology problem, with the human use and misuse of antibiotics accelerating the uptake of resistance.

“Over 50 million antibiotic prescriptions are made each year. Over half are unnecessary.”

Next, Laura McCaughey (University of Glasgow) explained the science behind antibiotic resistance – how it’s acquired, how it spreads between bacteria and how the bacteria spread themselves.

 “Over 50% of the antibiotics used worldwide are used in livestock”

Caroline Barker (University of East Anglia) then gave a clinicians point of view on the matter. She asked us if we had ever had surgery, cancer treatments and other illnesses and procedures that require antibiotics. She explained that without antibiotics, operations and treatments we take for granted, like abdominal surgery and cancer treatments would become impossible. We were reminded that we can recover from many illnesses without using antibiotics.

To finish off we had a question and answer session between speakers and the audience. Some interesting questions were asked, such as:

  • If we had been more careful with antibiotics, would resistance still have spread?

Yes, antibiotic resistance has been around from the beginning. Bacteria produce antibiotics themselves to kill other bacteria. If you’re a bacterium producing antibiotics, you have to be resistant to your own antibiotic or you would kill yourself! Antibiotic resistant bacteria have a competitive advantage compared to non-resistant microbes, so it is beneficial to them to spread resistance. Humans have just accelerated this process.

  • Is there a difference between the rates of antibiotic resistance in developing countries compared to developed countries?

It’s a global problem. Drug resistant TB has become a problem worldwide, including the UK.

Paul, Laura and Caroline answer questions
Paul, Laura and Caroline answer questions

It only takes one person carrying resistant bacteria in their gut to travel to a different country to pass these bacteria on to others!

  • What’s the solution – should we place more emphasis on monitoring patients taking antibiotics?

We already do this! Perhaps we prescribe courses that are too long?

Many patients expect antibiotics when they don’t need them. Patients need to be more aware of the risks of taking antibiotics and doctors shouldn’t feel the need to prescribe them for all illnesses.

  • What about looking in to novel places for antibiotics, like crocodile blood?

Not sure about crocodile blood, but there are scientists looking at deep sea bacteria and other extremophiles. Many of them make useful compounds, but it takes around 20 years to get drugs approved so we may not get them in time!

  • Why can’t we use bacteriophages instead of antibiotics?

Bacteriophages probably won’t replace antibiotics; they will need to be used in a cocktail with them. The problem is they are a live organism that self-replicate. Some of them actually spread resistance! There is a struggle to get them licensed because of this. If we can harness this technology it could be very beneficial but not necessarily the definitive answer.

  • What’s the answer? What would you like to see happen to combat antibiotic resistance?

It would be great to set up a panel as we did with climate change. This way a range of decision makers can sit down and talk the problem out. This is a worldwide problem, so even if we solve it in the UK it doesn’t matter. We need everyone to help.

We need to inform the public. Without them we won’t be able to find a solution. People need to be educated on how to combat resistance and to decide what they think is important to allocate funding for researchers.

The three speakers and Ian Harvey at the event
The three speakers and Ian Harvey at the event

The panels’ knowledge and enthusiasm for the subject combined with the fantastic audience participation lead to an interesting, exciting event. By discussing antibiotic resistance from medicinal and scientific perspectives, the session was informative and thought-provoking.

We would like to thank our speakers, Ian Harvey at Hills Road College and to our audience members for making this fantastic event possible.

If you would like to find out more about antibiotic resistance, we have created a useful booklet explaining what it is and how you can help limit its impact.

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