Resistance is futile - how the world became dependent on popping pills

Critical condition: Resistance to antibiotics is increasing.
Critical condition: Resistance to antibiotics is increasing.
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It changed medicine forever. But less than 90 years on is the golden age of antibiotics about to come to a spectacular end? Sarah Freeman reports.

Antibiotics revolutionised global medicine. Since Alexander Fleming made his almost accidental discovery of penicillin in a small London laboratory back in 1928, they’ve saved millions of lives, prevented countless infections turning fatal and seen off a thousand diseases. Yet they’re also in danger of being too successful for their own good.

Suffering a bout of flu? We demand our GP writes a prescription for a course of antibiotics we probably won’t see through to the end. As the unused tablets sit in bathroom cabinets, the bacteria it was designed to kill grows just that little bit stronger. It’s not just humans who have become reliant on them. With disease spreading rapidly through intensively farmed pigs, sheep and chickens, antibiotics have been used to keep the wheels of British factory farming turning for years.

And that’s not all. We pump antibiotics into everything from toothpaste to washing up liquid and when the maritime industry was looking for a way of keeping barnacles off the bottom of boats, it was again to antibiotics they turned.

They’re everywhere and like an overexposed celebrity we are becoming immune to their charms. So much so, that global resistance to antibiotics has been ranked alongside terrorism as one of the greatest risk we face in the 21st-century. Our relationship with antibiotics is fast looking like the ultimate cautionary tale.

“This isn’t a scare story being whipped up by the medical profession,” says Professor Laura Piddock, the microbiologist and founder of the public awareness campaign Antibiotic Action who this week delivered the Yarburgh Lecture at York University on the issue. “It’s a very real, very imminent threat and we need to deal with it.

“We are already seeing a significant number of people who are resistant to all antibiotic strains. We are at the top of a very slippery slope and we have to ensure we don’t end up at the bottom.”

Two years ago Margaret Chan, director of The World Health Organisation, told an assembly of infectious disease experts that the now widely predicted post-antibiotic era would mark an end to medicine as we know it.

What we think of routine operations could become too risky to carry out and minor injuries could once again prove fatal. According to the very worse case scenario, we could also be at risk of another global pandemic not unlike Spanish flu which in 1918 killed up to 100m people.

In recent years there has been an awful lot of finger pointing with agriculture routinely identified as the biggest culprit in the war against resistance. It’s with good reason. The most recent statistics show that while 54 per cent of all antibiotics produced are for humans, a staggering 40 per cent are sold for food producing animals.

However, according to Prof Piddock, who is based at Birmingham University, the time for apportioning blame is over and the time for serious action has come.

“The medics will blame the vets, the vets will blame the medics and if they are together they will blame another group. The reality is that society has undervalued antibiotics. We have allowed the world to become completely awash with them. In developing countries they have been used as a substitute for good sanitation. People drink contaminated water, they get ill and they are treated with antibiotics. It doesn’t solve the problem.

“Over here, did we ever need washing up liquid that contained antibiotics? Of course we didn’t, but it was a good marketing ploy wasn’t it? Yes we need to be open about where and how antibiotics are being used, but the horse has already bolted. We are staring resistance in the face, it’s a global problem and one that needs a global solution.”

It’s now estimated that 70 per cent of the world’s bacteria are resistant to current antibiotics and in Europe alone those strains are killing more than 25,000 people a year with related healthcare costs running at around £1.5bn euros.

So why don’t we just mobilise the brightest and best brains in science and encourage them to follow in Fleming’s footsteps by developing the modern day answer to penicillin?

If only it were that easy.

“Since the 1990s there has been a significant drop off in the amount of research and development being invested into the field of antibiotics by the big pharmaceutical companies,” says Prof Piddock. “There’s a simple reason for that. Money. There’s just not the return on investment that there used to be.

“There was a time when drug companies could make billions of dollars out of antibiotics. Now they can only make millions, so they have turned their attention to more lucrative enterprises. These are private companies, it is their job is to make money and so they go where the biggest return is.”

According to Professor Jeremy Farrar, head of Britain’s biggest medical charity the Wellcome Trust just four pharmaceutical companies are now working on developing antibiotics compared to the 18 which were involved in research two decades ago.

Part of the problem is that antibiotics are not only sold cheaply, but they are rarely prescribed for longer than a few months. Often a course of tablets last just a couple of weeks.

“Compare that with something like statins which someone takes for the rest of their lives,” says Prof Piddock. “That’s a lot of tablets and a lot of potential revenue.”

The answer may be to remove antibiotic research out of the commercial field and into academia, but that would require significant investments by governments who are struggling the world over with huge budge deficits.

Yet something will have to be done. Chief Medical Officer Dame Sally Davies has recently warned that we are just 20 years away from losing the ability to fight routine infections. If that happens it would instantly catapult us back to the pre-penicillin world of the 19th-century.

Since 2009, there has been a small drop in the level of antibiotic use. According to a European Commission survey published towards the end of last year those using antibiotics to treat a bout of flu has declined by two per cent, but given the scale of the problem it is but a drop in the ocean.

Tuberculosis is a case in point. Rife in England 200 years ago, the widespread use of antibiotics from the 1950s onwards effectively killed off the disease in this country. Successful treatment was one of the era’s biggest public health achievements, but the status quo didn’t last long.

By the 1980s there were signs that the decline had not only levelled out, but worse, the number of cases was actually beginning to rise again.

Current figures show that 500,000 people around the world now have a type of TB which is resistant to at least two of the main types of drugs used to treat the disease. While the majority of cases are confined to China, Russia and India, each year around 9,000 people are diagnosed in the UK.

“We know what the problems are but one of the reasons for setting up Antibiotic Action was a recognition that no one had really started to seek solution,” says Professor Piddock. “Medics and scientists had been talking to each other, but we had not really been talking to anyone outside our group.

“I think it has helped to get antibiotics on the agenda and I do think the public is gradually becoming aware. However, if we do not get new treatments to patients within the next two decades, patients will start dying of bacterial infections in greater numbers than they are today. There is absolutely no doubt about that.

“I’m not sure any of us know what the answer is just yet, but I am a born optimist and I do believe we will find a solution before time runs out.”

sarah.freeman@ypn.co.uk