Antimicrobial resistance: time is ticking
Warnings over increasing antibiotic usage, and the resistance to its healing effects that comes as a result, are increasing in frequency. But it would be fair to say that discussions about this topic do not maintain traction in the public eye to the same extent as issues like climate change or global terrorism, but they certainly should.
The effects of antibiotic resistance are no less serious and pose an equally substantive threat to human life. Figures from the World Health Organisation state that around 700,000 people globally die every year from drug-resistant infections and, if this trend goes unchecked, it is estimated that the annual death toll will be 50 million.
In the UK, England’s Chief Medical Officer, Dame Sally Davies, has been banging the drum to raise awareness of antibiotic resistance. Repeatedly, she has warned of a “post-antibiotic apocalypse” and in 2016 she suggested that antibiotic resistance should be considered as big a threat as global terrorism. When you look at the current data, few could blame her.
Public Health England (PHE) published a report in September revealing that 3 million surgical procedures, such as hip replacements and caesarean sections, could become resistant to antibiotics. Standard surgical practices would become extremely risky to perform and Dame Sally said in September that “we face a return to the dark ages of life-threatening surgery.”
Worrying trends in data suggest that we are already seeing the effects of antibiotic resistance in UK hospitals. Recent figures from NHS Digital have revealed that the annual rate of in-hospital infections have more than quadrupled in eight years, from 5,872 in 2008 to 24,800 in 2013 and 48,000 in 2017.
While some progress has been made in reducing the overall rate of antibiotic prescriptions (a fifth of which are considered to be ‘unnecessary’ by PHE), reducing overall usage is not in itself a solution to the problem, as performing some sorts of surgery without the use of antibiotics could potentially be lethal for patients.
Furthermore, focusing on inappropriate usage can often lead to blame being directed towards GPs. Professor Helen Stokes, chair of the Royal Society of GPs, recently said, “GPs will only recommend antibiotics if we genuinely believe they will help the patient sitting in front of us…antimicrobial resistance is a society-wide issue and GPs cannot be held responsible for tackling it on their own.
An array of challenges
The obvious solution to the problem is to create new drugs; however, there have only been a handful of new products created in the past few years and no new classes of antibiotics have been invented for decades. Alexander Fleming himself recognised that bacteria could eventually become resistant to drugs, so why in this age of medical innovation are we not able to produce new and revolutionary forms of antibiotic?
Basically, inventing antibiotics is extremely complicated and takes serious time. Discovering chemicals that kill bacteria is easy; what is not easy is developing substances from those chemicals that is not toxic to humans. After potential chemicals are discovered, a long period of medical testing follows – on average it takes around 10-20 years from discovery to produce a new antibiotic. Not exactly an attractive investment opportunity for pharmaceutical companies.
Despite the fact that we are now seeing 48,000 in-hospital infections a year, the issue of drug-resistant infections simply hasn’t occupied a consistent space in public debate. It does not have the same ‘face’ as a disease like cancer and those affected may think of their condition as a typical uncontrolled hospital infection rather than something more significant. Dame Sally Davies raised the idea of adding drug-resistant infections to death certificates in order to raise awareness amongst the families affected. In this context it could only serve to help and we need more ideas like this to maintain awareness of the issue.
A sustained global effort from governments is required, firstly in investing in promising new treatments and doing their utmost to bring them to market whilst promoting awareness of the issue amongst the general public. Additionally, improving hygiene in our hospitals and exploring the potential for pre-emptive vaccines will help stop drug-resistant infections spreading in the first place.