Future looks grim for anitbiotics but not entirely without hope

Overuse, inappropriate prescribing and poor patient compliance have all contributed to the diminishing usefulness of anitibotics and an alarming rise in drug-resistant 'superbugs'. But the war on disease is not yet lost.

A patient collects her medicine from pharmacy at Baniyas Clinic in Abu Dhabi.

The power of antibiotics to fight the germs that surround us is on the wane, according to some very recent, rather alarming news reports. But just how close are we to a "pharmageddon" where common diseases become incurable because of their drug resistance?

According to the World Health Organisation (WHO), an estimated 25,000 people died in Europe last year from bacterial infections that current antibiotics can no longer combat. "We're heading towards a post-antibiotic era in which many common infections will kill unabated," said Dr Margaret Chen, the director general of the WHO at the World Health Day appeal on April 7, which was this year earmarked to emphasise the need for new antibiotics and for tougher action to reverse growing drug-resistance.

The need to address the failing strength of antibiotics is clear but, as ever in the world of medicine, not all is cut and dried. Some experts have suggested that the power of pills to combat disease can only improve as our understanding of microbiology continues to develop, while others argue that the mighty pharmaceutical industry is unlikely to give in to antibiotic resistance without a fight.

"Research hasn't given up on antibiotics," Dr David Livermore, the director of the UK's Health Protection Agency antibiotic resistance monitoring department, tells The National. "But the chase to keep up has got much tougher. So much of modern medicine - from gut surgery to transplants - depends on our ability to successfully treat infection. That's why the issue of resistance to infections is so crucial."

The latest concern surrounding antibiotics has been sparked by a bacterium found in water supplies in New Delhi. The NDM-1 (New Delhi metallo-beta-lactamase) bug is resistant to almost all existing antibiotics including the most powerful type, carbapenems.

"New antibiotics are in development," says Livermore. "But these can take anything from five to seven years to get to a clinical trial stage and even then there's no guarantee that they'll actually be given a licence. Assessments for side-effects, for example, have to be done before new drugs get the green light."

In the meantime the bugs, of course, face no such legal restrictions in their Darwinian struggle for survival as they continue to adapt and evolve strains that outrun the current antibiotics. Livermore and experts such as Dr Lauri Hicks, medical director of the Get Smart: Know When Antibiotics Work programme at the US Centers for Disease Prevention (CDC), are desperate for the medical profession to change tack.

"Antibiotics are a shared resource - and, for some infections, are becoming a scarce resource," says Hicks. "The problem is, we expect antibiotics to work for every illness, but they don't. If you have a cold, antibiotics will not work for you."

Livermore agrees: "They're too often prescribed for viral ailments, which makes them the wrong tools for the job."

CDC research shows that while 75 per cent of all antibiotics prescribed by GPs are for upper respiratory problems, in 90 per cent of cases the actual cause of those problems is a virus doing the rounds.

However, overuse of antibiotics is not the only reason for the growing resistance to them. The rise in international travel, especially "health tourism", has also played its part in the spread of bacteria such as NDM-1. The medical journal The Lancet reported last August on UK patients with bacterial infections picked up after having treatments, including cosmetic surgery, in India and Pakistan.

Elsewhere, research by the Virginia Tech Institute, in Virginia in the US, has shown that, as with so many pharmaceuticals, antibiotics swallowed by humans and animals can pass through the body without being changed and then find their way - via sewage treatment plants - on to fields and into the food chain.

Vaccines are one possible way of dealing with the challenge to the power of antibiotics, but vaccination programmes are costly and difficult to manage among large populations. Another approach that may prove more practical and fruitful is highlighted by the recent response to the MRSA outbreaks in UK hospitals.

MRSA is a strain of the Staphylococcus aureus bacterium that has developed a resistance to antibiotics. While research laboratories rushed to find an antibiotic that could kill it, some health authorities noted that introducing more rigorous hygiene - better hand-washing and ward-cleaning - helped cut the incidence of MRSA in hospitals.

Studies by the Association for Professionals in Infection Control and Epidemiology also found that poor hygiene habits were the principal barrier to containing the spread of MRSA. At the same time, preclinical tests on new "superbug challengers", such as platensimycin, were found to prove successful against MRSA.

"The spread of antibiotic resistance underscores the need for good infection control in hospitals," says Livermore. As a result, the UK now has guidelines in place for hospital infection-control teams on how best to detect the new carbapenem-resistant bacteria, on screening and isolating high-risk patients and on ways to help to contain the spread of infection in a similar way.

Employing such practices helps buy time for pharmaceutical firms to develop new antibiotics. But Livermore emphasises that we all, as patients and doctors, have a responsibility to avoid extravagant or unnecessary use of existing treatments. "It's vital we conserve what antibiotics we have - using them carefully and prudently," he warns.

Dos and don'ts of medication

Do

• Complete your prescribed course. Stopping taking antibiotics early increases the risk of antibiotic resistance and can lead to more serious infections.
• Stick to the prescribed dosage amounts and when to take them. This is necessary to maintain the appropriate levels of medicine in the bloodstream.
• Check with your doctor for any side-effects, such as drowsiness, which may make it unsafe for you to drive when taking them.

Don't

• Disregard advice on what to avoid while taking antibiotics - for example, tetracycline antibiotics can be rendered ineffective by milk.
• Ignore instructions on how to take them. Some antibiotics work best when taken on an empty stomach, others shouldn't be taken with certain food and drinks.
• Take antibiotics that have not been specifically prescribed for you by someone who knows your medical history.