“It is not difficult to make microbes resistant to penicillin in the laboratory by exposing them to concentrations not sufficient to kill them … The time may come when penicillin can be bought by anyone in the shops. Then there is the danger that the ignorant man may easily underdose himself and by exposing his microbes to non-lethal quantities of the drug make them resistant.” – Alexander Fleming, Nobel lecture, 1945.
Antimicrobial resistance (AMR) in the form of superbugs is recognised as a grave threat to global health. Some bodies – like the World Health Organisation – consider superbugs as the gravest threat to human health today. AMR already causes an estimated 700,000 deaths annually and – at this rate – is predicted to cause 10 million deaths annually by 2050.
Introduction – antibiotics and AMR
Antibiotics can kill certain kinds of microorganisms. They kill bacteria or slow the growth of bacteria and have been used for decades as action against bacterial diseases.
Bacteria can carry genes that allow them to survive exposure to the antibiotics used to treat them. This means that infections caused by these bacteria are harder to treat, although they are not necessarily more severe or infectious. This is called antibiotic resistance and is an example of evolution in action.
Antibiotic resistance is a type of Antimicrobial resistance (AMR) – the ability of a microbe to resist the effects of medication previously used to treat it.
AMR is one of the most serious challenges faced by modern medicine.
Why is AMR rising?
Antibiotics should only be used when needed and as prescribed by medical professionals. The prescriber should closely adhere to the five rights of medication administration: “the right patient, the right drug, the right dose, the right route, and the right time”.
Rising drug resistance is caused mainly by improper use of antimicrobials in humans as well as in animals, and spread of resistant strains between the two. This has increased the need for alternative treatments – but new drug development is becoming rarer.
Superbugs and why AMR is so dangerous
“A few of [these superbugs] are literally resistant to everything. Fortunately, these are the exceptions rather than the rule. But the fact that we have any of these at all is cause for alarm because the only thing we can say is we’re sure to see more of these as time goes on.” – Robert Moellering, Harvard’s Beth Israel Deaconess Medical Center.
The gene that carries antibiotic resistance can be passed between bacteria, allowing for the creation of bacteria (over successive generations) that carry genes that enable it to be resistant many different antibiotics. This is called a superbug.
The World Health Organisation (WHO) has described superbugs as the greatest threat to human health. The international health organisation has said that new antibiotics must be developed urgently to fight a dozen dangerous families of bacteria which have become resistant to antibiotic action.
Antibiotic resistance spreads very quickly, far faster than microbiologists expected. As James Gallagher wrote, “As long as new drugs keep coming, resistance is not a problem. But there has not been a new class of antibiotics discovered since the 1980s. This is now a war and one we are in severe danger of losing. Antibiotics are more widely used than you might think and world without antibiotics would be far more dangerous.”
As mentioned above, AMR already causes an estimated 700,000 deaths annually and is predicted to cause 10 million annual deaths by 2050. Furthermore, according to World Bank estimates, deaths and medical costs from superbugs could cost poor countries 5% of their economies by 2050 – this would invariably lead to a global crisis.
“A ticking time bomb”
“This is a ticking time bomb because the bacteria are developing resistance mechanisms more rapidly now than we can find new antibiotics … And it is in a very real sense an emergency, and we need to deal with this soon, or we’re back to the pre-antibiotic era.” – Serena Altschul.
On 27 February, the WHO unveiled the first list of the world’s most deadly superbugs. This was done with the aim of urging businesses and governments to get serious about developing new antibiotics.
The list contains 12 drug-resistant bacteria classified according to urgency – “critical”, “high”, and “medium”.
In its first global report on AMR – released in 2014 – the WHO concluded that the threat was no longer a prediction for the future – it is happening right now in every region of the world and has the potential to affect anyone, of any age, in any country. The WHO warned that without urgent, coordinated action the world would head into a “post-antibiotic era” where common infections which have been treatable for decades would once again be epidemic and deadly.
What can be done?
“Antibiotic resistance is growing, and we are fast running out of treatment options. If we leave it to market forces alone, the new antibiotics we most urgently need are not going to be developed in time.” – Marie-Paule Kieny, Assistant Director-General for Health Systems and Innovation, WHO.
Global health experts have argued that an international legal framework is needed to prevent and control AMR. Binding global policies could be used to create antimicrobial use standards, regulate antibiotic marketing, and strengthen global surveillance systems. However, ensuring that signatories of such a treaty fulfil the treaty’s requirements and proposals will be a monumental challenge.
According to research by Emory University, Georgia, as much as 50% of antibiotic use is unnecessary or inappropriate.
Overuse, misuse, and the use of diluted medicines – all of these contribute to the rise of resistance in bacteria. Meaning, improper dosing of antibiotics, by fostering resistance in the bacteria they are meant to treat, enables the development and propagation of superbugs.
It goes without saying that without more funding for antibiotic research, superbugs cannot be stopped. Governments and private investors should fund scientists so that a way can be found to avert the impending global health crisis.
Additionally, there are a number of things we as the public can do to ensure the safe use of antibiotics and action against AMR:
- Using antibiotics only when prescribed by a doctor;
- Completing the full prescription, as prescribed by the medical professional, even if they feel better;
- Never sharing antibiotics with others or using leftover prescriptions;
- Health workers should enhance infection prevention and control;
- Antibiotics should be prescribed by doctors only when they are truly needed;
- Policymakers should regulate and promote appropriate use of medicines;
- Innovation and research should be advanced and extensively funded;
“Much of modern surgery relies on the risk of infection remaining low. At the moment, it is close to zero. [If superbugs and AMR] raise it to even 5%, let alone 10%, a lot of orthopaedic surgery, cataract replacements, and other discretionary but life-enhancing procedures would simply stop. That would not be the end of the world, but it would be a step backwards. And it would be a shame if it had been caused by a failure to take proper notice of a warning, all those years ago …” – The Economist, 2011.