The antibiotic apocalypse

15 December 2015

Interview with

Mark Holmes, University of Cambridge, and Nick Brown, Addenbrooke's Hospital

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News broke recently of bacteria discovered in China that are now resistant to antibiotics used normally as a last resort, prompting fears we could be on the cusp of an age where bacterial infections are no longer curable. So are we all doomed, or is this scare-mongering? Georgia Mills puts the problem under the microscope for us...

Georgia - On the 11th December, 1945 a man named Alexander Fleming won a Nobel Prize for the world-changing discovery of antibiotic penicillin.  Penicillin and drugs like it work by either killing bacteria or rendering them ineffective, and they’ve completely changed the face of modern medicine.  Upon receiving his prize, Fleming gave a speech during which he mentioned the threat of antibiotic resistance.  Fast-forward 70 years to the present day and headlines are cropping up everywhere about bacteria growing resistant to so-called "last resort" antibiotics.  The words "post-antibiotic apocalypse" have even been used. So how worried should we be, and how did we get into this mess? I went to visit Dr Nick Brown, a consultant medical microbiologist at Addenbrooke’s hospital in Cambridge...

Nick - Resistance is a natural phenomenon and in many respect, I think, it can be inevitable that following exposure, bacteria will develop resistance. The bacteria mutate so that they are able to evade the action of the antibiotic.  The key to the current problem, I think, is that whereas in the 1950s and1960s, whenever antibiotic resistance developed, we were able to replace an antibiotic with a new one.  Now we are in a situation where there have been no truly new antibiotics in the last 20 years or so and, one of the big concerns that we have now, is the pace in which resistance appears to be proliferating is increasing.

Georgia - So why is the rate of resistance increasing?  Well, we’re using antibiotics all the time in medicine.  They’re used in hospitals for operations and are prescribed by doctors but, humans are not the number one user.

Mark - The vast majority of the antibiotics that are used are in this country and in Europe are used in the therapy of infectious disease in farmed animals.

Georgia - That’s Dr Mark Holmes from the Department of Veterinary Medicine at the University of Cambridge.

Mark - Well, the big problem is not that we use too much antibiotics on healthy animals but we probably have too much endemic disease in farm animals.  You and I will favour cheaper meat and the farmers and the agriculturalist are very good at developing husbandry systems that produce cheap meat.  The downside is that these animals are relatively stressed so they tend to have higher levels of endemic disease.  There’s another issue and that is to keep the costs down, it’s not feasible to treat individual animals so, if you get a pen of animals and you get one or two that develop diarrhoea, then the antibiotics tend to be given to the whole pen rather than to the individual animal, and that is probably something that is less than ideal from the point of view of generating antimicrobial resistance.

Georgia - If we keep going at this current rate, what kind of world do we have in store for us?  Nick…

Nick - As close as some parts of Southern Europe, there are infections in patients where there are no antibiotics left to treat infections and in those situations, obviously, the outcomes of severe infection are poor.  Going forward some years, you would think that there’s a possibility that some infections that we now take for granted can be treated, might not be able to and that threatens the very nature of the way that we practice health care at the moment.  For example, without antibiotics we wouldn’t be able to have a safe hip replacement; without antibiotics you couldn’t have cancer chemotherapy, you couldn’t have a kidney transplant so, antibiotics are absolutely vital to the way that we live at the moment and the way in which we expect our healthcare to be delivered.

Georgia - It’s quite scary stuff.  So what do we do about it?

Nick - There are lots of things that being done about it.  One is to try and protect the antibiotics that we do have left and that is trying to improve the way that we use antibiotics; don’t use antibiotics when they are not needed.  Then the second broad area in which we can try and attack this issue is to consider how we can get new antibiotics into development and onto the market and, again, there are lots of initiatives to look at small drug discovery companies and, indeed, into the larger pharmaceutical companies to try and re-stimulate this market which is broken for many reasons, including for the fact that it’s not a financially viable market for those companies at the moment.

Georgia - If anyone is looking for new mould, I think I have some species as yet unknown to science in my fridge.  But what about the current rates of use in agriculture?  Dr Mark Homes…

Mark - The main issue here is our drive for cheap food and a free market economy.  Farmers are under incredible pressure to produce foods at lower and lower costs, and you and I as consumers, through our purchasing power at supermarkets, are responsible.  So it’s the system that’s at fault, not individual interest groups and most of the time we deal with this with legislation. So, in China and in North America, antibiotics are used for growth promotion, so healthy animals can be given antibiotics to make the sort of grow faster – something that goes back to producing cheap food.  In Europe, we recognise that using antibiotics for growth promotion is not a good idea and we have legislation in place.  That creates a level playing field, so we need strong regulation and strong leadership.

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