Are we heading towards the antibiotic apocalypse?

IT is impossible to say just how many lives penicillin, the world’s first antibiotic, has saved over the years. Antibiotics revolutionised medical care in the second half of the 20th century but increasingly the bugs are fighting back.

In 2013, England’s Chief Medical Officer Dame Sally Davies described the growing resistance to antibiotics as a “ticking time bomb” and said the danger should be ranked alongside terrorism and global warming on a list of threats to the nation.

This was followed last year by David Cameron’s stark warning that the world could soon be “cast back into the dark ages of medicine” unless action was taken to tackle this threat.

These fears have come into sharp focus recently following a warning that the world is on the verge of a “post-antibiotic era”, after it emerged bacteria had been identified in China that were able to shrug off the so-called drug of last resort in both patients and livestock.

The news has raised the spectre of a future world without antibiotics – a world where a simple cut to your finger could be potentially fatal.

It would mean basic operations, like getting your appendix removed or having a knee replacement, would suddenly be dangerous, while cancer treatments and organ transplants could kill you.

It sounds like something from a dystopian science fiction story, but it’s the nightmare scenario that we could one day face.

We aren’t there yet, and such an apocalyptic future may be averted, but at the same time modern medicine faces a constant battle to try and stay ahead of the threat from infectious diseases.

Researchers and scientists at the University of Sheffield are working on the front line of this battle using two ambitious projects, called Florey and Imagine, to push back the boundaries of our biological understanding and help protect us.

Professor David Dockrell, Joint Florey Project Director, says the findings in China need to be put into context.

“This particular problem that has been discovered in China is currently extremely rare from a clinical perspective and the general public doesn’t need to be too alarmed at present.”

He points out, too, that researchers and scientists are busy working hard to find alternatives to combat bacteria that have become highly resistant to antimicrobials.

However, Prof Dockrell believes we have to look more closely at how antibiotics are used.

“We do need to find suitable alternatives but we also need to look at ways of restricting the use of current antimicrobials so we preserve their use,” he says.

Although it is very rare to find bacteria as resistant as this it is still a wake-up call to scientists and researchers. So are we in danger of facing a so-called “antibiotic apocalypse” in our lifetime?

“The concern would be if we didn’t take this latest problem seriously and didn’t make sure we maintained a pipeline of new drugs and therapies, in which case it could happen,” says Prof Dockrell.

It is down to policy-makers and the international community to work together to ensure we don’t reach that stage.

“You’re only as strong as the weakest link and though one region might have a very effective policy another region might not and highly resistant bacteria can spread quickly. It’s something the global community needs to be aware of because we can’t tackle this in isolation.”

Dr Philip Howard, a consultant pharmacist in antimicrobials at Leeds Teaching Hospitals NHS Trust, says the fact that some bacteria are developing resistance to the antibiotic that is used as a last resort when all others have failed is a concern.

“It’s not necessarily the end of the world, but we are moving towards a time where we don’t have antibiotics available and that is worrying.”

There are some grounds for optimism, though. “We have seen the amount of antibiotics prescribed by doctors and dentists start to fall and we’ve seen the resistance rates of some types of bacteria that have caused us serious problems, like MRSA, begin to drop.

“With the most common form of pneumonia, streptococcus – which is a really big killer – we’ve seen the number of cases drop by a quarter over the last five years because of a new type of vaccine.”

However, he admits that this doesn’t ease the problem of growing resistance among some bacteria to an ever widening cocktail of pharmaceutical drugs. “The bugs that cause us most problems are the bugs that live inside our guts and unfortunately once they become resistant it’s very hard to reverse.

“Doctors can normally find a combination of antibiotics to treat people with and they will fully recover, but this is going to become increasingly difficult in the future.”

The World Health Organisation is spearheading the battle to control this resistance, while research teams are constantly looking at developing new treatments, although it’s fast becoming a race against time.

Dr Howard, who is also a spokesman for the Royal Pharmaceutical Society, admits there may come a time when antibiotics are redundant. “Certainly we are getting closer to that stage, although it will take many years. But I think we will see more patients getting infections that are resistant to all antibiotics and unfortunately there will be many more deaths because antibiotics won’t work.”

The elderly and patients whose immune systems have been compromised, such as those who have had liver and kidney transplants, would be most at risk.

However, Dr Howard insists the picture is not as bleak as some people are suggesting. “Whilst this is scary there is an awful lot that people can still do to help. Making sure that they wash their hands before they eat and ensuring they have all the vaccinations available to them, this can all make a difference.”

Part of the problem has been people’s over reliance on antibiotics in recent decades and the misplaced belief that they are some kind of cure-all.

Instead, many doctors want to see individuals taking greater responsibility for their own health. “People need to look after themselves and perhaps use their community pharmacy rather than going to their GP and asking for antibiotics, because it can be difficult for GPs to say ‘no’ to patients.”

Which is why Dr Howard believes we all have a role to play. “It’s the job of society to look at how we use antibiotics, rather than just relying on healthcare professionals and scientists to discover new ones.”

A warning from the past

Sir Alexander Fleming made one of the single greatest contributions to medicine when he discovered penicillin, after noticing that mould growing on his culture dishes had created a ring free of bacteria.

But as far back as 1945 the spectre of resistance was already there, as he himself warned.

“It is not difficult to make microbes resistant to penicillin in the laboratory by exposing them to concentrations not sufficient to kill them, and the same thing has occasionally happened in the body.

“The time may come when penicillin can be bought by anyone in the shops. Then there is the danger that the ignorant man may easily underdose himself and by exposing his microbes to non-lethal quantities of the drug make them resistant.”