These days we don’t think much about the possibility of having access to antibiotic treatment to prevent infection. But this has not always been the case: antibiotics have been available for less than a century.
Before that, patients died from relatively insignificant infections that became more serious. Some serious infections, such as those involving the heart valves, have been inevitably fatal.
Other serious infections, such as tuberculosis, were not always fatal. Up to one half people died within a year with the most severe forms, but some people recovered without treatment and the rest suffered from a persistent chronic infection that slowly ate away at the body for many years.
Once we had antibiotics, the outcomes of these infections were much better.
Life (and death) before antibiotics
You’ve probably heard of Alexander Fleming’s accidental accident discovery of penicillinwhen fungal spores landed on a plate containing bacteria over a long weekend in 1928.
But the first patient Receiving penicillin is an instructive example of the impact of treatment. In 1941, Officer Albert Alexander had a scratch on his face that became infected.
He was hospitalized but despite various treatments, the infection progressed to reach his head. This required removing one of his eyes.
Howard Florey, the Australian pharmacologist then working at Oxford, feared that penicillin was toxic to humans. Therefore, he felt it was ethical to give this new drug to a patient in desperate condition.
Agent Alexander received the available dose of penicillin. From the first day, his condition began to improve.
But at the time, penicillin was difficult to produce. One way to expand the limited supply was to “recycle” the penicillin excreted in the patient’s urine. Despite this, supplies ran out on the fifth day of Alexander’s treatment.
Without further treatment, the infection returned. Constable Alexander ultimately died a month later.
We now face a world in which we risk running out of antibiotics, not because of manufacturing difficulties, but because they are losing their effectiveness.
What are antibiotics used for?
We currently use antibiotics in humans and animals for a variety of reasons. Antibiotics reduce the duration of illness and the risk of death from infection. They also prevent infections in people at high risk, such as patients undergoing surgery and those with weakened immune systems.
But antibiotics are not always used appropriately. Studies consistently show that a dose or two will adequately prevent infections after surgery, but antibiotics are often continued for several days unnecessarily. And sometimes we use the wrong type of antibiotic.
Investigations found that 22 percent of antimicrobial use in hospitals is inappropriate.
In some situations this is understandable. Infections in different parts of the body are usually caused by different types of bacteria. When the diagnosis is not certain, we be mistaken exercise caution in administering broad-spectrum antibiotics to ensure we have active treatments for all possible infections until more information is available.
In other situations, there is some inertia. If the patient’s condition improves, doctors tend to simply continue the same treatment rather than switching to a more appropriate choice.
In general medicine, the issue of diagnostic uncertainty and therapeutic inertia is often amplified. Patients who recover after starting antibiotics usually do not need tests or return for an examination. So there is no easy way to know if the antibiotic was actually necessary.
Prescribing antibiotics can be even more complex if the patients waiting for “a pill for every ailment”. Although doctors are generally good at informing patients when antibiotics are not likely to be effective (e.g., for viral infections), without confirmatory testing, doubt lingers in the minds of doctors and patients. Or sometimes the patient goes elsewhere to find a prescription.
For other infections, resistance can develop if treatments are not given long enough. This is in particular the case for tuberculosis, caused by a slow-growing bacteria that requires particularly long antibiotic treatment to cure.
As in humans, antibiotics are also used to prevent and treat infections in animals. However, some antibiotics are used to stimulate growth. In Australia, a estimated 60 percent of antibiotics were used in animals between 2005 and 2010, despite the phasing out of growth-promoting drugs.
Why is overuse a problem?
Bacteria become resistant to the effects of antibiotics through natural selection: those that survive exposure to antibiotics are the strains that have a mechanism to escape their effects.
When resistance to commonly used first-line antibiotics emerges, we often have to dig deeper into the bag to find other effective treatments.
Some of these last-line antibiotics are those that have been replaced because they had serious side effects or could not be easily administered in tablet form.
New drugs against some bacteria have been developed, but many are much more Dear than the oldest.
Treat antibiotics as a valuable resource
The concept of antibiotics as a valuable resource has led to concept of “antimicrobial stewardship”, with programs to promote the responsible use of antibiotics. It is a concept similar to environmental management aimed at preventing climate change and environmental degradation.
Antibiotics are a rare class of drugs in which the treatment of one patient can potentially affect the outcome of other patients, through the transmission of antibiotic-resistant bacteria. Therefore, like efforts to combat climate change, antibiotic stewardship relies on changing individual actions to benefit the community as a whole.
Like climate change, antibiotic resistance is a complex problem when viewed in a broader context. Studies have linked resistance to values and priorities governments such as corruption and infrastructure, including the availability of electricity and utilities. This shows that there are broader “causes of causes,” such as public spending on sanitation and health care.
Other studies suggested that individuals need to be considered as part of broader social and institutional influences on prescribing behavior. Like all human behavior, prescribing antibiotics is complicated, and factors such as what doctors consider to be a “normal” prescription, whether junior staff feel they can challenge senior doctors, and even their Political Views can be important.
There are also problems with the economic model to develop new antibiotics. When a new antibiotic is first approved, the first reaction of prescribers is not to use it, either to ensure that it maintains its effectiveness or because it is often very expensive.
However, this does not really mean encourage the development of new antibiotics, especially when pharmaceutical research and development budgets can easily be devoted to developing drugs for conditions that patients suffer for years rather than days.
The slow pandemic of resistance
“If we do not act, we will face an almost unthinkable scenario in which antibiotics no longer work and we return to the dark ages of medicine.” — David Cameronformer British Prime Minister
Antibiotic resistance is already a problem. Nearly every infectious disease doctor has received the dreaded call about patients with essentially incurable infections or for whom they’ve had to scramble to find long-forgotten last-line antibiotics.
A global study It is estimated that in 2019, nearly 5 million deaths occurred as a result of infection involving antibiotic-resistant bacteria. Some 1.3 million cases would not have occurred if the bacteria were not resistant.
The United Kingdom in 2014 O’Neill Report Deaths from antimicrobial resistance are projected to reach 10 million deaths each year and cost between 2 and 3.5 percent of global GDP by 2050, based on current trends.
What can we do about it?
We can do a lot to prevent antibiotic resistance. We can:
Monitor for infections caused by resistant bacteria to inform control policies.
Reduce inappropriate use of antibiotics in animals, such as promoting growth.
Reduce cross-transmission of resistant organisms in hospitals and the community.
Continue to develop new antibiotics and alternatives to antibiotics and ensure the right incentives are in place to encourage a continuous pipeline of new drugs.
Allen Cheng is Professor of Infectious Disease Epidemiology at Monash University. This piece first appeared on The conversation.