Antibiotic resistance - everybody's problem
The Chief Medical Officer has called for urgent action to reduce antibiotic resistance to stop a global disaster in 20 years' time.
She describes it as a 'ticking time bomb' which could plunge us back into the bad old days where infection during major operations could kill as many people as the surgery itself. I wish I could disagree, but my reading of the evidence is that she's absolutely right.
Some problems in this complicated picture we can't do anything about. Bacteria are very clever little blighters who adapt with astonishing speed to survive. The principles of evolution and survival of the fittest are based on living beings adapting because of mutations when they breed. Most mutations are either harmful or have no effect either way. But if a mutation leaves the organism better adapted to survive, it will produce more offspring than its neighbours and, after thousands of generations, will become the dominant player in its own little world. Humans reproduce every 20-30 years. Bacteria can reproduce every 10 minutes.
When antibiotics were first mass-produced in the early 1940s, 95% of infections with the germ Staphylococcus aureus were sensitive to basic penicillin treatment. Within four years of widespread antibiotic use, the first penicillin-resistant strains of S. aureus started emerging, and today we have regular health scares due to MRSA - a form of S. aureus resistant to multiple antibiotic treatments. Infections with other bacteria, such as E. coli and klebsiella, have increased faster still and now account for 44% of cases of the infection of the bloodstream, known as septicaemia.
The Chief Medical Officer has called for worldwide work to curb antibiotic resistance, including discussion at the G8 Summit and addressing the issue of antibiotics given to healthy animals. You may feel the urge to lobby your MP, but there's not much I can do about this from my consulting room.
But some of the other issues contributing to antibiotic resistance we can all help with. Firstly, taking part of a course of antibiotics and stopping once you feel better, rather than finishing the course, is a perfect way to encourage growth of resistant germs.
Secondly, both doctors and patients need to think carefully before prescribing and demanding antibiotics. Thirty years ago, antibiotics were the answer to every maiden's prayer - if patients had a cough, doctors would prescribe them on the basis that they might help, and if they didn't, no harm would be done. Today doctors are well aware of the possible side effects, which range from allergies to possibly life-threatening infection with the bacterium C.difficile.
Despite this, I am only too aware that some of my colleagues 'give in' and prescribe antibiotics without clear indication that they are needed. I suspect there have been times when I have, too - although I really, really try not to! It may be that sometimes they're given 'just in case', if the doctor isn't confident about the diagnosis. It may be that rarely (I hope) they're given to finish the consultation quickly, and avoid a protracted discussion about why they aren't necessary.
However, in my experience, more often they're given because the doctor has been worn down by a patient who is completely convinced that antibiotics are the only answer. Patients come in all too regularly and greet me with the words: 'I've just come in for some antibiotics'. If I try to explain, after a full history and examination, that antibiotics aren't necessary, their next comment will be along the lines of 'but I've got a wedding I have to be well for' or 'I know that's true for everyone else, but I know my body'.
They really seem to believe that I hold the cure, and they just have to find the right magic words to make me open up my Pandora's box. It's high time patients realised that's not the way it works.
It is peculiarly ironic that Dificlir®, one of only three new antibiotics developed in 20 years, was developed specifically to treat an infection caused by - you've guessed it - taking antibiotics. We may have heard this news before, but if we don't take note some time soon the consequences could be beyond our worst imagining.