The end is nigh


I read an erudite article the other day, showing that anti-biotic resistance will breed “superbugs” which will kill off the inhabitants of this planet in the next 50 years. Wow! That is worrying. Or is it?

You see, I would have given more credence to the warning if I hadn’t read the same predictions 20 years earlier.

Now I am not denying that the bacteria are changing – they are. But by the same token, so are we!

When we look at the efficacy of bacteria, history will show us that 75 years ago, penicillin was a “wonder drug” initially, until the bugs started to eat it for lunch. So we developed ampicillin, followed by amoxicillin then augmentin, and then augmentin plus clavulanic acid. What’s next? Supermox? (Note to Big Pharma: I thought of the name first!)

The research into antibiotics went further than the penicillin line and now we have Cephalosporins, Chloramphenicols, Macrolides, Beta-Lactams, Quinolones, Tetracyclines and more, with even newer antibiotics being tested right now.

The reason the ever-expanding list of antibiotics has come through was the successive lines began to show that the bacteria were becoming less sensitive to the antibiotics used.

Perhaps some information on how we judge antibiotic sensitivity is in order. This is generally done by taking a swab of infectious (bacterial) material and smearing it over a container with agar (like a jelly). Next to the tested swab contents are small amounts of several different antibiotics and after a couple of days the laboratory technician examines the agar plate and can see which antibiotic best stopped the growth of the bacteria. That then is the antibiotic of choice for the infection.

That method of choosing the best antibiotic for that particular infection unfortunately belongs to the ideal world. The ideal world we don’t live in! Does the doctor say, “I’ll send this off to the lab and I’ll get you back in a couple of days and I’ll write you a prescription.” Yes, and the delay in initiating treatment? Are you then prepared for the additional costs of culture and sensitivity?
So in our less than perfect world, does the doctor have a clinical “guess” and give you an antibiotic that “should” work to take while you are waiting for the lab results which you will pay for? Or does the doctor guess, and tell you to come back if you don’t improve and at that point, the lab investigation begins? Ah, the clinical dilemma.

Of course there is the third option, which goes some of the way to the emergence of the superbugs – self medication. In many SE Asian countries, “prescription” medication is available OTC (over the counter) and that includes antibiotics. Is there any way of your choosing the correct antibiotic? Simple answer, no.

The report released about the superbugs has made suggestions on ways to combat this growing threat. It suggests we need to improve hygiene and prevent the spread of infection.

“Improving hygiene and sanitation was essential in the 19th century to counter infectious diseases,” the report said.

“Two centuries later, this is still true and is also crucial to reducing the rise in drug resistance – the less people get infected, the less they need to use medicines such as antibiotics, and the less drug resistance arises.”

For all countries, the focus will be on the health care systems and limiting the spread of superbugs in hospitals. Proper hand-washing is key, while it sounds simple, it could be a huge step forward in combating the rise of the superbug.

The report also says there are circumstances where antibiotics are required in agriculture and aquaculture – to maintain animal welfare and food security; however, much of their global use is not for treating sick animals, but rather to prevent infections or simply to promote growth.

In the US alone more than 70 percent of antibiotics that are important for humans, are sold for use in animals.

Countries should also look at promoting the development and use of alternatives to antibiotics, like vaccines.

“Vaccines can prevent infections and therefore lower the demand for therapeutic treatments, reducing use of antimicrobials and so slowing the rise of drug resistance,” the report said.