Bad news sells papers. Or as Elliot Carver, the media mogul set on world domination in the Bond film Tomorrow Never Dies put it: “There’s no news like bad news.”
As a scientist, my responsibility is to separate fact from fiction, to follow evidence, not instinct. So when I read doomsday reports of a coming “antibiotic apocalypse”, I question their legitimacy. Are we really all standing on the edge of the medical precipice, about to tumble into an oblivion of death-by-superbug? We most certainly are not.
The end of the world may well be on the horizon, but it surely won’t be due to antibiotic resistance. In order to understand why, you need to understand resistance: where it comes from, what it can do, and crucially, what scientists are doing about it.
Predominantly, antibiotic resistance is a man-made problem. Since the discovery of penicillin in 1928, we have consistently provided the opportunity for resistance to evolve, persist and spread through the mismanagement and incorrect administration of antibiotics.
We have also learned major lessons in the last decade as to where antibiotic resistance comes from and what measures we can take to control it. Some of these, such as the C-reactive protein (CRP) test – which can help detect if patients actually need antibiotic drugs or not – are proving to be highly effective, while others haven’t been and have occasionally even exacerbated the problem.
Sensitivity testing before use
The point is, scientists all over the world are working tirelessly to think up new and innovative solutions to the problem. Despite their best efforts, and a growing understanding of antibiotic resistance, we still sometimes get it wrong.
A woman in the US recently died of an infection so incredibly resistant that “there were no antibiotics left” to treat her. Some hysterical headlines described the deadly bacteria as a “superbug resistant to all available antibiotics”, because 26 different types failed to work.
But was her infection resistant to all of these before she was given the very first antibiotic? The answer is undoubtedly, no. Fundamentally, bacteria are given an opportunity to develop resistance.
Sensitivity testing allows infections to be tested against different antibiotics in a lab to see if they will be effective. While this was carried out on the woman’s infection, it was already too late – somewhere along the line, she’d had too much exposure to inappropriately used antibiotics and the infection had become resistant.
Sensitivity testing at the start of an infection should be standard practice. The first questions doctors should be asking are “What antibiotics will actually work against this?” and “What am I up against?” so that any prescription will be effective in the first instance.
More progressive hospitals with microbiology labs are beginning to do this as a matter of course to better control and manage antibiotic resistance. There isn’t always time, for example with sepsis, which moves very fast, but for chest, skin, and urinary tract infections the results can be available within 24 hours. Treatment is then based on fact rather than a guess. If you get it wrong enough times, you get resistance. Failing to test for bacterial sensitivity early on in the infection, waiting instead until it is known that the infection is resistant, makes the scenario much worse.
Claims that the use of colistin, a “last hope” antibiotic, is soaring in English hospitals is true. But this is driven by a failure to test for antibiotic sensitivity before it is too late, leading to a need to turn to colistin. Clinicians often assume everyone’s urinary, respiratory or other infection is the same, and will respond in the same way to tried and tested antibiotics. Scientifically speaking, everyone’s infection is different and should be treated as such.
No apocalypse in sight
Sad as the death of the woman in the US is, it is not uncommon for a death to result from resistance. Reports suggest that around 700,000 people die from antibiotic resistant infections globally each year, the majority in underdeveloped countries with poor access to healthcare. This number is predicted to rise to 10m deaths a year by 2050 if nothing is done about the problem.
But “apocalypse” is the wrong word for this. The global population has doubled since World War II, when around 10m people a year died. Humankind certainly won’t be wiped out. Even if we were to face the worst case scenario by 2050, antibiotic resistance would affect about 1% of people on the planet.
And that is assuming we sit back and do nothing. In fact, 1,618 scientific research papers were published on antibiotic resistance in 2015. There is lots of funding into resistance and scientists are doing lots to tackle the problem. Schemes such as the Longitude Prize – a prize for scientists that has currently set a challenge for creating a cost-effective, accurate, rapid and easy-to-use test for bacterial infections – are pushing the momentum of discovery in this area.
Spread the word, not bacteria
Although more money is always needed for research, the secret to halting the spread of antibiotic resistance is, and will always be, education. Washing your hands after going to the bathroom, blowing your nose, and before you eat, will reduce infection and the spread of bacteria in the first place. Knowing that antibiotics are ineffective against viruses such as cold and flu, and that if you are prescribed antibiotics it’s of paramount importance that you finish your course, even if you feel better, are vital.
Keeping a record of the type of antibiotics you have been prescribed for an infection is also a good thing to do, so that if your infection comes back when you finish the course (indicating possible resistance), you can take a different type next time. With antibiotics, if it didn’t work the first time, it won’t work the second time. The more we do all these things without a second thought, the better.