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ANTIBIOTICS USEFULNESS IS FINITE

So the game now is to keep bacteria at bay. Hygiene is an obvious weapon. Better cleaning, hand gels and stern warnings to staff and public alike have helped reduce infection rates in hospitals. But Professor Richard James, director of the centre for health care infections at the University of Nottingham, warns that bugs don’t stay in hospitals (the NDM 1— producing bacteria appears widespread in India, passed through contaminated water, in which people bathe, wash clothes and defecate).

“The worry is once these organisms are out in the community,” says James.

“There probably is some need for public education about infection and, for instance, kitchen hygiene when you are cooking. People of my generation were taught a lot about washing your hands before every meal. It was automatic that it was done. A lot of that has gone.”

Beyond that, there is a real need to conserve those antibiotics we have.

Like oil, he points out, antibiotic usefulness is finite. And the cost of drug resistance is not reflected in the price of the drug. “If you consider antibiotic sensitivity as a resource like oil, you want to maintain that by introducing a tax,” he says. It would be worldwide and the proceeds could fund new drug development.

But should you tax life-saving drugs, especially in poor countries?

“If you don’t do anything, there won’t be any antibiotics anyway,” says James starkly. “At least it is a suggestion of something that could be done.”

Walsh’s paper shows that no country can pull up the drawbridge. “It illustrates the importance of considering health issues as a world issue — how antibiotics are prescribed and controlled in one part of the world can very rapidly have consequences elsewhere,” says Christopher Thomas, professor of molecular genetics at the University of Birmingham.

Sadly, the fact is that many people have still got their heads in the sand.

In the battle for survival of the fittest between human beings and bacteria, it looks as though the best we are going to get is a draw — if we are lucky.

The Guardian

NOT OVER YET BUT ...

But it is not just an issue in advanced medicine.

Antibiotics are vital to abdominal surgery.

“You safeguard the patient from bacteria leaking into the body cavity,” he says. If you lose the ability to treat these infections, appendix operations would carry the same risk as they did before Fleming discovered penicillin in 1928.

It may not be over yet, he says, but “we are certainly scraping the bottom of the barrel to find antibiotics that are effective against some of the infections.”

Running out is not the only issue, he says. When somebody has a severe infection — say blood poisoning — causing a high fever, a hospital clinician will dispatch blood samples to the lab to find out exactly what he is dealing with. But that takes time. “He will start you on antibiotics because that will kill infection within 48 hours,” says Livermore. “So during 48 hours, you are being treated blind.

The more resistant your bacteria are, the less likely the antibiotic is going to work.”

Studies have shown, he says, that the chances of dying from hospital pneumonia or septicaemia (blood poisoning) are twice as high if the bacteria are drugresistant, rising in the case of pneumonia from 20 to 30 per cent to 40 to 60 per cent.

For a long time now, doctors have known they were in a race to stay a few steps ahead of the rapidly growing resistance of bacterial infections to antibiotics.

Ten years ago, the so-called superbug MRSA caused front-page panic.

Hospital patients were picking up Staphylococcus aureus infections that were resistant to the hitherto powerful antibiotic methicillin. An all-out war against MRSA has reduced the threat of what are known as Gram-positive bacteria. Hospital hygiene has been massively stepped up and, in response in part to public anxiety, pharmaceutical companies have put money into finding new antibiotics for these infections.

But it’s like putting a finger in a hole in the dam, only to find the water surges out somewhere else. Bacteria are great survivors. The biggest threat now, experts believe, is from multi-drug-resistant Gram-negative bacteria, such as NDM1- producing enterobacteriaceae and an enzyme called KPC which has spread in the US (and in Israel and Greece) which also gives bacteria resistance to the most powerful group of antibiotics we (once) had.