Rise of the superbugs

This is the way the world ends, this is the way the world ends, this is the way the world ends, not with a bang but with…..antibiotic resistance.

Antibiotic resistance is the major threat to my generation. In the next 20 years or so, resistance will have emerged so much that antibiotics will become redundant. We are already seeing many cases of resistance against Vancomycin – an antibiotic of last resort, and already 700,000 people a year are dying from untreatable bacterial infections. This is only set to rise with a (conservative) estimate of 10 million deaths a year in 2050 due to antibiotic resistance.

Antibiotic resistance is caused by exposing bacteria to an antibiotic, but at a lower level than that is capable of killing them. The bacteria, with the aim to survive,  identify the antibiotic as a threat and undergo mutations in their DNA to become resistant to the function of the antibiotic. For example, the bacteria may mutate to increase the function of a pump on their cell wall, thus increasing the amount of antibiotic that is pumped out of the bacteria before it has chance to work.

Wide spread blame for resistance is placed on doctors for handing out antibiotics ”like sweets”, but can they take all the responsibility?

The simple answer is no, as the patients are also to blame. When prescribed antibiotics, the full course must be taken even if your symptoms have eased or disappeared as there will still be the bacteria lurking in your system, just fewer of them. These bacteria if not fully wiped out, can begin to multiply again and develop resistance to the antibiotic by mutating to survive.

An alternative exposure source is using antibiotics in livestock. Some farmers administer antibiotics to healthy animals to increase growth and milk production. When the animals excrete, antibiotics can leech out and enter rivers and groundwater, providing a perfect opportunity for bacteria to mutate against a low dose of antibiotics.

It really is an evolutionary arms race between bacteria and us, but bacteria can multiply and evolve much much quicker than humans with E. coli dividing every 20 minutes given the optimum conditions. Meanwhile, antibiotics take years to be developed and to be approved safe for human use. If bacteria become resistant to one drug, another antibiotic needs to be developed to target the bacteria using a different approach.

It has previously been reported that drug companies will be fined if they do not develop new antibiotics. This is an infuriating proposal if true. This is NOT the way to go about drug discovery. Drug companies need to be funded and encouraged to develop new antibiotics which is no easy task and doesn’t come cheap! Taking more money from the experts in drug discovery will only hinder progress.

The issue surrounding antibiotic development is that the antibiotic will be saved for last resort, to reduce exposure and the likelihood of resistance emerging. Therefore, drug companies have no financial incentive to develop antibiotics as they won’t be sold often enough to make a profit or even pay off the research costs. It has now been proposed that the government will give 2-12 drug companies between £200,000 and £2 million on a competitive basis to research the development of antibiotics.

I really don’t think we are taking the antibiotic resistance crisis serious enough. A simple bacterial infection could end up killing us, and given the opportunity to spread, we could see the rise of a new ‘plague-like’ epidemic. Super-gonorrhea is already becoming prevalent and can lead to infertility.  Routine operations such as cesareans will be much more risky due to the chance of contracting an untreatable bacterial infection. We will be going back to the dark-ages.

I think we are in the mind set of ‘we will deal with it when it happens’ – by then it will be far too late.