In 1943, during the twilight of the second World War, the impact of the first non-experimental doses of penicillin was difficult to overstate: illnesses that were once death sentences became not just survivable but readily treatable.
Soldiers who would have previously succumbed to their wounds recovered and lived into old age; infections from accidents, cuts and childbirth no longer carried the sting of death in their tail. The success of penicillin led to new antibiotics and advances; within decades, diseases like tuberculosis, which had once killed thousands annually in Dublin alone, had ceased to be the threat they once were.
Yet even as he accepted the 1945 Nobel Prize for the discovery of Penicillin, Alexander Fleming issued a salient warning: “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.” These prophetic words have fallen Cassandra-like on deaf ears and now the spectre of antibiotic resistance threatens us all. Recently, Dr Keiji Fukuda of the World Health Organisation said: “Without urgent, co-ordinated action by many stakeholders, the world is headed for a post-antibiotic era, in which common infections and minor injuries which have been treatable for decades can once again kill.”
This is not some potentiality in the hazy distant future – it is already happening worldwide. Diseases like gonorrhoea, pneumonia, ecoli infections, staph’ and tuberculosis have acquired immunity to many classes of antibiotics, and have begun claiming lives on an unprecedented scale.
Once treatable diseases The Centres for Disease Control and Prevention
estimate that in America alone at least two million people a year develop a serious antibiotic resistant infection and 23,000 die from these infections, with a similar number in European dying from these once treatable diseases.
This eventuality is not unexpected; bacteria are quick to divide and evolve rapidly. As a consequence doses below the threshold required to kill the malignant bacteria might reduce symptoms in the carrier but promote the evolution of disease strains capable of shrugging off our arsenal of antibiotics, returning us to a darker era where a minor cut or scrape could again be fatal, and where a simple bacterial infection might spell death.
One common misconception is that antibiotics are a panacea for minor illnesses, when in fact they have no effect whatsoever on viral ailments and are frequently over-prescribed, dispensed by put-upon GPs to patients eager for a totem to their discomfort.
To further exacerbate the issue, there has been severe stagnation on the development of new antibiotics – pharmaceutical companies have become wary of sinking money into agents which are only used for a short period per patient and quickly rendered obsolete due to overuse.
Surprisingly, the majority of all antibiotics are consumed not by humans but by animals – given in sub-therapeutic amounts, antibiotics act as growth promoters. In 2006, the EU banned antibiotics in livestock for anything other than medicinal use, but in the US up to 80 per cent of antibiotics are given to livestock.
Front-line drugs A growing weight of evidence indicates that while this increases profitability, it
reduces the effectiveness of our front-line drugs.
The question is how we mitigate this disaster; first, we owe it to ourselves to be better informed about when antibiotics should be used, and better communication between physician and patient might help spare overprescription.
Reducing antibiotic use in livestock is of paramount importance, and it is encouraging that the EU is taking steps in the right direction. We also cannot rely solely on profit-motivated drug companies to offer us new solutions, and part of the solution may be to invest more public money in research.
We are all guilty of the ignorance that Fleming warned of almost 70 years ago and if we are to avoid disaster, it is vital we educate ourselves in their proper usage.
Dr David Robert Grimes is a science writer and physicist at Oxford University. He blogs at davidrobertgrimes.com