Newspaper headlines often depict an apocalyptic future, in which antibiotic resistance jeopardises medicine as we know it.
Yet, this prospect can be avoided. Clinicians and researchers are approaching the problem of antibiotic resistance from three angles simultaneously:
- Preventing infections
- Developing new antibiotics
- Antibiotic stewardship: Preserving existing antibiotics
Preventing infections in the first place is an easy way to avoid using antibiotics, therefore avoiding the potential emergence of new antibiotic resistant bacteria. This includes action on many front, ranging from hand washing to water sanitation.
Preventing the transmission of infection from one person to another is another important strategy. Being in hospital increases your risk of picking up infections. One of the most effective ways to prevent infection spreading is proper hand-washing, but many other approaches exist which can also be used to stop the spread of infection.
Developing new antibiotics
One obvious answer to the problem of antibiotic resistance is to develop new antibiotics. As bacteria become resistant to older antibiotics, we can simply introduce new ones. This was the approach that was taken in the past, but it has become far more challenging today.
First, this is only a temporary solution. With time, nearly all bacteria develop resistance, and we are back to square one. We cannot predict how long this takes, but science shows this is an inevitable fact of bacterial life. The first records of bacteria resistant to antibiotics were only a few years after the first antibiotics went on the market.
Second, developing a new antibiotic is difficult and expensive. When drug companies develop new drugs, they need to sell the new drugs widely to recover the money they have invested. However, doctors and policy makers want to keep newly discovered antibiotics in a cupboard and only use them when all our existing antibiotics have stopped working. This is to prevent bacteria from developing resistance to the new antibiotic.
Unfortunately, this makes investing in antibiotics extremely unattractive to a pharmaceutical company. This may be a reason why no new class of antibiotics has been discovered and licenced since the 1980s. You can read more about this problem in a report on the antibiotic pipeline published in 2015 as part of the Review on Antimicrobial Resistance.
Antibiotic stewardship: Preserving existing antibiotics
We know that antibiotic resistant bacteria thrive when use of antibiotics is high, so it makes sense to reduce our antibiotic use. There are risks and benefits associated with this.
Take the scenario of a child who sees their GP with a fever. The child probably has a virus and does not need antibiotics but their parents are really worried and the child is not their usual self. Not giving antibiotics could lead to a severe infection. Although this is pretty unlikely, the doctor might not be willing to take this risk. In practice, balancing the population benefits of not prescribing against the risk to the individual of infection-related complications can be very difficult in the absence of fast and accurate diagnostics.
Making sure that antibiotics are only prescribed for patients who really need them comes under the umbrella concept of ‘antibiotic stewardship’. Antibiotic stewardship consists in promoting and monitoring judicious use of antbiotics to preserve their future effectiveness. Antibiotic stewardship pursues two objectives:
- treating infections effectively
- minimising adverse effects of antibiotics, which include antibiotic resistance.
Several antibiotic stewardship interventions are already in use in the UK. Below are some examples that are widely implemented:
You can read more about the initiatives that are being used to tackle the problem of antibiotic resistance in the UK Government’s National Action Plan on Tackling Antimicrobial Resistance.