Antibiotics - what's behind the latest headlines?
The Prime Minister, David Cameron, has called for global action to tackle antibiotic resistance. We've heard it all before - last year, it was the Chief Medical Officer who described a 'ticking time bomb' of growing resistance to life saving antibacterial drugs. Earlier this year the World Health Organisation warned that within our lifetime we could be facing an era where minor infections could become deadly. So what's new now?
The World Health Organisation highlighted two major causes for this rise of superbugs - the first was overuse of antibiotics. In my 24 years as a GP, I have seen little change in demand for antibiotics. That's despite decades of attempts to educate the public on when they might help and when they are at best useless and at worst can do more harm than good. What have changed are my patients' reasons. In the 1990s, far fewer people realised how many infections, particularly coughs and colds and sore throats were caused by viruses, or that antibiotics were completely useless against these invaders. Today we live busier lives than ever, and nobody has time to be ill. Most of my patients know that antibiotics won't touch viral infections, but they want them 'just in case' their infection could be bacterial after all. They know it's important to use antibiotics wisely, but everyone seems to have a reason why they should be the exception who gets them - more than one has advised me that I should 'keep antibiotics for emergencies - except for me'.
Doctors must bear some responsibility too. In a world where being sued is an ever present threat, and a prescription will get the patient out of the consulting room far quicker than a long explanation of why they shouldn't have one, some doctors may be tempted down the 'just in case' route.
Some people are at very high risk of bacterial infection. For them, withholding antibiotics could be disastrous - people with chronic lung conditions like COPD or bronchiectasis are often given supplies of antibiotics to keep at home and take at the first hint of a flare-up of their condition. Other infections from tonsillitis to urine infections also need antibiotics. The second issue cited by the World Health Organisation report as a cause of rising resistance was people failing to take courses of antibiotics properly.
David Cameron has warned that the world could soon be "cast back into the dark ages of medicine" if governments and drug firms fail to act. He points out that 25,000 people a year are dying in Europe alone from antibiotic-resistant infections. The Prime Minister has raised the issue at a G7 summit, hoping to engage an international response. He has also commissioned an economist to work up a plan to put to the G7 on speeding up discovery and development of a new generation of antibiotics.
There's no question that new antibiotics are few and far between, with only three developed in the last 25 years. But like all politicians, David Cameron is wary about telling his voters that they need to take responsibility too. Governments can encourage drug firms to search ever harder for new antibiotics. But they can't be there in every consultation, and they can't make patients take their medicines properly. That bit is down to all of us.