Antibiotic CapsuleWhen Alexander Fleming discovered Penicillin in 1929, it was without question one of the greatest moments in medical history; all for the good of Mankind.

However, when Mankind colludes with greed, the medicine that was once our saviour becomes our slayer.

In March 2014, Professor Dame Sally Davies presented her findings to the House of Commons Science and Technology Committee. Chair of the Committee Andrew Miller MP stated:

“Antimicrobial resistance is one of the most significant threats to public health today. I am pleased that Dame Sally Davies, Chief Medical Officer, is taking this seriously. However, we want to find out whether the Government’s current and proposed actions will contribute enough to tackling this serious global threat.”

The World Health Organization (WHO) defines antimicrobial resistance (AMR) as resistance of a microorganism to an antimicrobial medicine to which it was originally sensitive … so standard treatments become ineffective … increasing the risk of spread to others.

SUPERBUGS

Since the 1980’s scientists have been unable to keep up with the evolution of bacteria as it mutates into ever stronger bacterial strains. The emergence of meticillin-resistant Staphylococcus aureus (MRSA) or ‘superbugs’ has left many of the antibiotics ineffective, once more leaving the human race vulnerable to infection, with some diseases returning after decades of inactivity. Health experts also warn we will return to 19th century levels of safety when routine operations have a high risk of infection.

Following hip replacement surgery, the mortality rate in 2003-2011 dropped from 0.56% to 0.29% with just 1,743 out of 400,000 patients dying within 90 days of the operation. Over the next 20 years, this trend is likely to reverse as bacteria become resistant to antibiotics.

A March 2014 report shows an increase in the number of patients who have not responded to treatment by carbapanems – antibiotics that are used only when all the others have failed. The number of carbapanem resistant hospital infections rose to 600 in 2013 from just 5 in 2006.

The WHO estimate there are 150,000 cases of multi drug resistant Tuberculosis (MDR-TB) per year and the numbers are increasing. In New Delhi metallo-beta-lactamase (NDM-1) is a new bacterium that is resistant to treatment.

So how has this been allowed to happen? How can organizations and governments continue to support the excessive use of a medicine to our detriment?

ANTIBIOTIC TRENDS

Antibiotics have been prescribed to treat symptoms including chest infections, sore throats and juvenile ear infections. The two most common forms are Penicillin: amoxicillin and flucloxacillin.

Others include

  • Cephalosporins: cefalexin and cefixime used to treat a wide range of symptoms e.g. pneumonia and meningitis.
  • Aminoglycosides: gentamicin used widely until they discovered it caused damage to hearing and kidneys now only used for serious illnesses like meningitis.
  • Tetracyclines: covers a “broad spectrum” for conditions like severe acne and rosacea (flushed skin and spots).
  • Macrolides: erythromycin and spiramycin for lung and chest infections and as an alternative to Penicillin or to treat Penicillin resistant bacteria.
  • Fluoroquinolones: ciprofloxacin and norfloxacin used to “treat a wide range of infections”.

REALITY STRIKES

Antibiotics are used to treat or prevent bacterial infections, from acne to pneumonia but some infections are viral which do not respond to antibiotics.

The reality is anitbiotics are unlikely to help the recovery rate and for some people, there can be unpleasant side effects including being sick, indigestion and diarrhea. Additionally when a patient does not complete the course, it gives the bacteria a chance to redesign itself and become resistant to the antibiotic.

INTENSIVE FARMING

But it’s not just antibiotics being given to people that causes the problem; small dose growth promoters or sub therapeutic antibiotics are being routinely given to farmed animals; cattle in particular so they eat less food but put on the same amount of weight or eat their usual amount but put on significantly more weight.

Many animals are also given prophylactic antibiotics to prevent infection and full strength for a herd or flock. Lambs are given antibiotics including amoxicillin within hours of being born to prevent Watery Mouth Disease. However, these diseases can be controlled by less intensive farming and improved livestock hygiene.

There are no regulations to stop farmers using the ‘last resort’ drugs intended for use in human medicine.

The ‘Alliance to Save our Antibiotics’ said if the “profligate excesses in farming are allowed to continue then preventing or persuading doctors to reduce prescribing antibiotics will be futile”.

DEPARTMENT OF HEALTH RISK REGISTER

England’s Chief Medical Officer Professor Dame Sally Davies presented her findings to the House of Commons Science and Technology Committee in March 2014:

Chair: are you still of the opinion that antimicrobial resistance should be on the national risk register?
Prof. Dame Sally Davies: I am. If anything it has got worse … it is already on the Department of Health and DEFRA risk registers … it should go on the national strategic risk register before Christmas. One of my concerns is how antibiotics in the animal kingdom are used … for growth promotion.”

CONCLUSION

If the practice of using medicine to replace reasonable animal husbandry is allowed to continue and doctors persist in prescribing antibiotics unnecessarily, then we can expect to see a return to early 20th century health with an increase in mortality rates following routine surgery or illness and bacteria that cannot be eradicated or controlled.

Antibiotics – Saviour Or Slayer?

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