Antibiotic resistance, like global warming, is a threat to our future that keeps popping up in the media. The topic moved centre-stage today, with the long awaited publication of a major report that specifies the severity of the risk, and the measures that need to be taken to avert the threat.
It’s a long report, at 84 pages, and it’s worth reading for those with a serious interest in the subject, but here’s the gist of what’s being said.
Antibiotics are critical for modern medicine and surgery
First, the issue: antibiotics are a special category of antimicrobial drugs that underpin modern medicine (and veterinary medicine). If they lose their effectiveness, key surgical procedures (such as intestinal surgery, caesarean sections and joint replacements) and important medical treatments that depress the immune system (such as chemotherapy) for cancer) could become too dangerous to perform.
Why should antibiotics lose their effectiveness? Basically, bacteria are sometimes able to develop mechanisms to avoid being killed by antibiotics, developing so-called “resistant strains”. These are then able to multiply in the presence of the antibiotic, rendering the drug useless. There are many factors that predispose to antibiotic resistance, but essentially the more often antibiotics are used, the more likely bacteria are to develop resistance.
Antibiotic resistance could soon kill more people than currently die from cancer
How big is the problem? At the moment, 700,000 human deaths happen every year due to antibiotic resistance. If current trends continue, by 2050 this will reach a figure of 10 million deaths every year; more people than currently die from cancer. The economic cost is equally shocking, an unimaginable trillions of dollars in wasted antibiotics that don’t work and the consequent medical outcomes.
Ten steps to solve the problem
So what can be done? The report makes ten recommendations, and global government action is needed to put these into place.
- A global public awareness campaign to educate all of us about the problem of drug resistance, and in particular children and teenagers. Ignorance can only make this issue worse.
- New drugs need to be developed to replace the ones that are not working anymore because of resistance. A truly new class of antibiotics has not been developed for decades.
- Use antibiotics more sparingly in humans and animals, to reduce the unnecessary use that speeds up drug resistance. By 2020, it should be compulsory that the prescription of antibiotics can only be allowed if there is data to support the choice. One specific suggestion is a new tax on antibiotics for animal use to make them less attractive.
- Develop new, more rapid diagnostic tests to help doctors and vets limit their use to only cases where they are genuinely needed.
- Reduce the extensive and unnecessary use of antibiotics in agriculture, restricting the use in animals of antibiotics that are vital for human health. The widespread advertising and marketing of antibiotics for animals should be reviewed.
- Promote development and use of vaccines and other alternatives to prevent infections from developing in the first place.
- Improve the numbers, pay and recognition of people working in infectious disease. Currently, infectious disease doctors are the lowest paid of 25 medical fields in the USA.
- Establish a Global Innovation Fund for early-stage and non-commercial research which is just not being done at the moment.
- Better incentives to promote investment in new drugs
- Build a global coalition for real action – via the G20 and the UN
The most relevant aspect of the report to vets is obviously number (5): can we do more to limit antibiotic use in animals? HealthForAnimals, the Global Animal Medicines Association, believes that we are already doing enough but perhaps it takes outsiders to view our activities with a clear objective eye.
What can small animal vets do to limit antibiotic usage?
The reduction of antibiotic use on farms is a significant recommendation in the report, while their use in pets isn’t even mentioned. But small animal vets use antibiotics every day, and we need to examine our own roles in this area. If you read the veterinary press, it’s common to see third generation cephalosporins – one of the most advanced groups of antibiotics – being marketed as a first line antibiotic for vets in small animal practice. Meanwhile when humans go to their GP with common problems like chest infections, medical doctors seem to have become far better than vets at avoiding antibiotic use, not using antibiotics at all for minor infections, and only using older drugs like amoxycillin if antibiotics are judged to be absolutely necessary. More modern antibiotics like amoxycillin-clavulanate are only prescribed if the simpler drugs don’t work. In contrast, it’s standard practice for vets to choose these “stronger” drugs as a first choice. It’s easy to see why vets do this – we want our patients to get better as rapidly as possible, with the least possible risk of treatment failing. We justify this as “looking after animal welfare”, but if medical doctors can take a stronger anti-antibiotic line than vets, do we need to think again?
Vets in practice have got far better at using antibiotics appropriately, but should our industry be doing even more to help with this serious problem?