New Antibiotics: From ‘ticking time bomb’ to Collaborative Success
Last year’s headlines revealed that the number of patients given antibiotics for minor ailments has soared, despite awareness of bacterial resistance amongst both patients and GPs. In particular, a set of figures from Public Health England and University College London uncovered a worrying trend: Whilst in 1999 just 36% of patients were given antibiotics for coughs and colds, by 2011 this figure had soared to 51%. This is despite the fact that viruses – not bacteria – are often responsible for these ailments. Moreover, giving antibiotics un-necessarily breeds bacterial resistance, rendering specific antibiotic drugs powerless over time.
The trend came as quite some surprise, and concerns about the future prompted me to take ‘a little light reading’ on my summer holiday in the form of a slim Penguin paperback, which I read on a short flight: The Drugs Don’t Work by Professor Dame Sally Davies – who happens to be the first female Chief Medical Officer for England. You can watch her speaking here.
The book starts off by providing a whistle-stop tour of the history of antibiotics, from the infamous accidental discovery of the bacteria-eating mould, penicillin, by Alexander Fleming, to its timely mass production during WWII, through to development of other classes of antibiotic which have helped to revolutionise not just medicine, but daily life – for the majority of the world.
Some key facts:
Antibiotics add 20 years to our lives on average
It has been 27 years since a new class of antibiotics has been discovered
Resistant bugs kills 25,000 people per year in Europe – the same number as die in road traffic accidents
But factoids aside, the book serves as a warning in its largest sense: We have been using and abusing these life saving medicines to the extent that they are becoming redundant because, in the true Darwinian sense, the ‘bugs’ fight back. Put simply, when antibiotics are abused (courses not completed by the patients, the wrong drugs prescribed, over-use by the farming industry) the bacteria that manage to survive can pass on resistance via their genes to the next generation.
More worrying still, the pharmaceutical industry has not kept up by providing a regular stream of new antibiotics to counter the inexorable march of evolution because they have seen little profit in doing so. Their prevailing perception is that the cost of development is not matched by the potential return on investment, partly because antibiotics tend only to be used for days rather than months or years (compared to long-term drugs for treating diabetes, dementia, cancer and so on.) Added to which, antibiotic misuse leads to resistance, shortening the overall saleability of their drug. Interestingly, a potential solution Dame Sally offers to this reluctance is to extend the patent period from 20 to 25 years. Food for thought…
Certainly, solving the problem of antibiotic resistance won’t be easy, but the book presents several options. Arguably the most interesting of these involves the genomic revolution, whereby the ‘troublesome’ bacteria’s genetic code is mapped in order to tailor a precise treatment – rather than using the blunter option of treating it (and other bacterial species) with a broad spectrum drug that would kill off helpful bacteria, and breed resistance in other species of bacteria, too.
Gene mapping can now be done for as little as £100 and is becoming an ever faster technique, which can make all the difference for the patient, because a population of bacteria can double in number of hours under the right conditions. That said, Davies cites the case of a major pharmaceutical company that spent 7 years testing over 500,000 compounds in 67 screening programmes against potential bacterial targets: In the end, only 5 of the targets showed any promise, and not a single one of the compounds made it to the clinical trial stage.
Yet, far from predicting world doom, instead, the professor implores scientists and governments to work together to find solutions to counter the frightening scenario of going to the medicine cabinet only to find it bare. For certain, incentives must be in place. As long ago as 1795, Napoleon put up a reward of 12,000 francs for whoever discovered a way to preserve food for his troops. Not long after, Nicholas Appert invented the canning process which used heat treatment of food in sealed champagne bottles. (We presume the champagne wasn’t wasted…)
Later this year, the Longitude Prize will provide £10m to the winner that finds an easy, cost-effective test for bacterial infections that medics can use to determine if, and, when, to give out antibiotics.
If Napoleon can do it unilaterally, surely we can club together at a global level to find new antibiotics to replace the ones that aren’t working. In the meantime, we must all preserve antibiotics for their right and proper use, and this requires education: Teaching people from a young age will help, via projects such as the Europe-wide E-Bug www.e-bug.eu that is tailored for various ages, using engaging content.
Regular hand washing for 20 seconds with soap and hot water – especially before eating. (A study of 3,700 people at bars in Michigan showed that 1 in 10 people didn’t wash their hands and a third didn’t use soap after using the loo!)