In Part 1, we looked at how bacteria become resistant to antibiotics, and how without these drugs, modern medicine (surgery, chemotherapy, organ transplantation) would be almost impossible. In this second part, we’ll look at what drives resistance in the real world, and how we can help.
What drives the development of resistant strains of bacteria?
One of the reasons that the world has been so slow to start trying to tackle antibiotic resistance is that it’s such a complicated issue – and of course, everyone blames someone else! Doctors tend to blame farmers for using too many antibiotics in their animals; farmers blame the drugs companies for not producing more drugs; drug companies blame vets for prescribing the wrong types of antibiotic; and vets blame doctors for prescribing too many of them. In reality, of course, it’s everyone’s responsibility.
The thing to remember is that every use of antibiotics encourages resistance to develop – every animal and human on the planet carries trillions of harmless bacteria in their gut and on their skin, and every time we take a dose, these bacteria are all exposed. So, let’s have a look at the biggest drivers of antibiotic resistance in the world today:
- Many GPs across the world will still routinely prescribe antibiotics for viral diseases, and also for mild, self limiting conditions that really don’t need them. This applies to both human doctors and veterinary GPs!
- The reasons are partly because the patient or client demands them, partly to be seen to be doing something, and partly for fear of being sued if they’ve missed a bacterial illness.
- Inappropriate use in farm animals.
- In some countries (although not the UK) it is common practice to prescribe low doses of antibiotics to encourage faster growth in meat animals. Although this has been banned in Europe, it is still widespread in America and the Far East. Of course, use of antibiotics in animals that are healthy is going to cause resistance!
- A similar problem is seen with prophylactic and group dosing. These are situations where one animal in a group is sick (for example, with pneumonia) and all the others are treated, to prevent them from getting sick.
- Use in farm animals is a major worry, as a recent study suggested that 24% of chicken sold in UK supermarkets contained bacteria that were resistant to penicillin- and cephalosporin-family antibiotics (used for treating severe infections and blood poisoning); 51% of chicken and pork contained bacteria resistant to trimethoprim (widely used to treat urinary infections in people), and 19% carried bacteria resistant to gentamicin (a very potent drug used for severe infections).
- Availability without prescription.
- Although in the UK it is illegal to purchase or use antibiotics without a medical or veterinary prescription, in many countries (especially in Africa, the Far East and even Southern Europe) it is possible to buy very potent antibiotics over the counter. As a result, people overuse them, and don’t use them properly.
- Incorrect use of antibiotics.
- Have you seen those adverts that do the rounds occasionally, telling you to always complete the course of antibiotics? That’s because the courses prescribed are worked out to be sufficient to kill the bacteria being treated, to minimise the development of resistance.
- A course that is too short may result in partially resistant bacteria surviving.
- That said, a course that is too long risks over-exposing non-resistant bacteria, making them resistant too.
- Antibiotic dumping.
- This is very much the elephant in the room, that no-one wants to talk about! Most drugs companies manufacture in the US, Europe or (increasingly) the Middle East; countries with high environmental standards.
- However, in India and some other countries, there are factories producing antibiotics that dump their waste directly into watercourses. This waste isn’t always properly treated; there are reports of a factory dumping tonnes of vancomycin (a “last resort” antibiotic for resistant bacteria) into its local river every year.
- This sort of behaviour will do more damage than any number of inappropriate prescriptions from your GP.
What can we do about it?
Everyone involved can – and must do something to help, otherwise we’re looking at the end of modern medicine.
- Doctors and vets
- Reduce prescriptions of antibiotics, reserving them for situations where they are required, and likely to be useful.
- Follow local antibiotic protocols and guidelines to minimise the use of multiple different antibiotics in the same patient.
- Try to reserve more modern antibiotics for cases of resistant bacteria.
- Farmers and farm-animal vets
- Avoid antibiotic use for growth promotion.
- Avoid prophylactic dosing.
- Use herd-health planning and vaccination to minimise the development and spread of infectious disease.
- Drug companies
- Continue researching new antibiotics, and alternatives to antibiotic therapy.
- Stop antibiotic dumping (those who haven’t already)!
- Introduce stricter laws controlling who can supply antibiotics and when.
- Develop financial incentives to encourage drugs companies to innovate and clean up their act.
- Us as the public
- Don’t demand antibiotics for everything (for you or your pet!).
- Use them as directed – don’t skip doses, or stop half-way through the course, or share them with a friend.
- Don’t buy antibiotics without a prescription – always get yourself and your pet properly diagnosed by a doctor or a vet (delete as appropriate!) and follow their recommendations for treatment.
If we work together, we can’t stop antibiotic resistance – but we can slow it down and preserve the use of these incredible, vital medicines for future generations.