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Drug induced nightmares

I am currently receiving a daily IV drip of antibiotics for an infected arm, following an operation. It is slightly inconvenient, makes me feel a bit nauseous and sleepy. However, without antibiotics I would probably have lost my arm.

Today, UK’s chief medical officer, Dame Sally Davies, has said antibiotic-resistant diseases pose an apocalyptic threat and the issue should be added to the national risk register of civil emergencies. She can see a scenario, whereby people going for a routine operation could die from infection because we have run out of antibiotics that work.

The issue of drug resistance is as old as antibiotics themselves (1942) and arises when drugs knock out susceptible infections, leaving hardier, resilient strains behind. The survivors then multiply and, over time, can become unstoppable with front-line medicines. The best known are the hospital superbugs, such as MRSA. My particular strain goes by the cute name osteomyelitis, since you ask.

Alan Johnson, clinical scientist at the Health Protection Agency, said: “In the past, most people haven’t worried because we’ve always had new antibiotics to turn to. What has changed is that the the development pipeline is running dry. We don’t have new antibiotics that we can rely on in the immediate future or in the longer term.”

So, how has it come to this?

We have used antibiotics for 80 years to fight disease, but they are growing resistant- we should never use them to treat winter colds, for example; they have little effect and boost bacterial resistance. A battle plan needs to be drawn up.

There must be another way to combat the sniffles everyone seems to currently have. Pharmaceutical companies make a fortune from the medicines we all occasionally use and which rarely do anything more than slightly relieve the miserable symptoms, usually just paracetamol; why don’t they plough this money into a proper cure?

This is a war and every time we use antibiotics we reveal our arsenal to the enemy; oversubscribed antibiotics accelerate the problem. Antibiotics are handed out like sweeties – between 2003 and 2006 there was, in the UK, a 10% increase in prescriptions to children and in France over half of patients receive antibiotics for flu-like symptoms.

Half of antibiotics are actually given to livestock as growth promoters and you can also keep them alive in absolute squalor if they ingest the drugs. The result; we take them unwittingly and they become less effective at combating disease.

Quite simply, pharmaceutical companies are not investing in the new weapons we need to fight this war – there have been no new classes of antibiotics since 1987.

In the 1990s it was thought genomics was the solution and would lead to new antimicrobials, but it hasn’t yet. Finding new antibiotics will not be easy; natural antibiotics, made by other bacteria, plants or fungi may already be resistant and novel drugs pose an issue. Basically, the drugs companies don’t want to invest in a challenge that might not pay off.

Humans are top of the food chain and we feel we can control or eliminate any natural predators we may face, but it is actually the tiny enemies that might see us off; without effective drugs we will become the prey. The fight will be continuous, but we need to plan properly, which means getting the pharma giants behind us in the war effort.

Academia and private companies need to work together; old antibiotics may be of help, but we will need to use things we have not yet thought of, whilst curtailing our use of antibiotics in medicine and agriculture. As a patient, stop demanding antibiotics and as a doctor, stop chucking them at every problem.

It’s hard to get too worked up about something you can’t see, but when you’re sitting with a drip in your arm, knowing it’s curing you, it is quite sobering to think that in 20 years time we may have no weapons left.

Nigel Phillips

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