Antibiotic-resistant bacteria are a genuine threat we must all fight

http://www.guardian.co.uk/commentisfree/2013/jan/24/antibiotic-resistant-bacteria-threat-medicine

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More people died of infections than cancer in 2010. This stark fact highlights the danger from rise in antibiotic resistance in bacteria, a danger the chief medical officer warned MPs about again this week.

For billions of years, certain bacteria have produced chemicals that protect them from attack by other microorganisms. Some of these chemicals make up the antibiotics used in medicine today. Unfortunately, bacteria are survival experts and have developed ways of resisting the toxic effect of these drugs. In fact, most of the resistance that is around today developed many years ago, either in the local environment, or in people and animals. Global travel is a major contributor to the increasing spread of such bacteria, exacerbating previously manageable problems of resistance.

It may sound improbable, but by the time a person becomes an adult, there are more bacterial cells in the body than human cells. It is easy to see that some of these billions of bacteria may have natural genetic mutations that bestow antibiotic resistance. Taking antibiotics creates "selective pressure" where sensitive bacteria are killed leaving a gap in which any resistant bacteria can flourish. Most frequently, resistant bacteria are spread from person to person via direct contact, environmental surfaces, water and food, but it is clear that taking antibiotics unnecessarily also presents its own risks. What can be done to improve our current scenario of bad bugs-few drugs?

There is no easy answer, but several steps can be taken. Governments, drug companies, doctors, patients and the walking well all have a role to play. Apart from two agents, no truly novel types of antibiotic have come onto the market for 40 years. It is difficult and expensive to develop such medicines and because they are taken for short courses, unlike cardiovascular or cancer drugs, they do not generally generate a high income for a pharmaceutical company.

That is a shame as antibiotics are one of the few drugs that actually cure people rather than just holding symptoms at bay. It is one area in which governments could help – by using antibiotic pricing policies for example, perhaps setting a minimum reimbursement price for drugs that treat resistant infections, and improved tax credit systems for developers.

Grants could also be targeted to support the development of new drugs to combat resistant superbugs. Stringent regulatory requirements have also made getting antibiotics onto the market very difficult in recent years. Regulatory reform is badly needed in order to encourage companies back into antibiotic research – thankfully this is now happening, at least with antibiotics against certain key target bacteria: in Europe regulators are looking at ways of getting drugs designed to combat Eskape organisms through clinical trials much more quickly.

The use and misuse of antibiotics in medicine and farming over the past 70 years has led to an increase in the number and type of antibiotic resistant bacteria. Clearly, the fewer antibiotics that are used the less chance of resistance developing. Prescribing practices could be tightened both by doctors, but also by patients who must come to understand that antibiotics don't work for viral infections and may not therefore be necessary.

For patients, taking the correct dose of an antibiotic, at correctly spaced intervals during the day, means an active level can be maintained in the body, giving the highest chance that all the harmful bacteria causing an infection will be killed and limiting selective pressure. Hygiene both at home and particularly when visiting hospitals is key, and a simple way in which we can all do our bit. We need new types of antibiotics and then we need to use these wisely – if we don't we will return to the days of survival of the fittest, and the huge advances in medicine that we benefit from will be rolled back. Patients will die of infections that we should be able to treat.