After finding bacteria resistant to drugs used when all other treatments have failed, scientists have warned the world is about to see a “post-antibiotic era”.
They identified bacteria able to shrug off the drug of last resort – colistin – in patients and livestock in China. They said that resistance would spread around the world and raised the spectre of untreatable infections.
The so-called antibiotic apocalypse, i.e. bacteria becoming completely resistant to treatment, could plunge medicine back into the dark ages. Common infections would kill once again, while surgery and cancer therapies, which are reliant on antibiotics, would be under threat.
Resistance was reported in a fifth of animals tested, 15% of raw meat samples and in 16 patients. And it spread between a range of bacterial strains and species, including E. coli. There is also evidence that it has spread to Laos and Malaysia.
If antibiotic-resistant gene MRC-1 becomes global, which some experts believe is a case of when not if, and the gene aligns itself with other antibiotic resistance genes, which is inevitable, then we will have very likely reached the start of the post-antibiotic era.
Resistance to colistin has emerged before. However, the crucial difference this time is the mutation has arisen in a way that is very easily shared between bacteria. Some hospitals are now frequently struggling to find an antibiotic – an event which was extremely rare only five years ago.
The concern is that the new resistance gene will hook up with others plaguing hospitals, leading to bacteria resistant to all treatment – what is known as pan-resistance.
Early indications suggest the Chinese government is moving swiftly to address the problem. It is also already being discussed whether colistin should be banned for agricultural use. Several experts are warning that the same antibiotics should not be used in veterinary and human medicine.
Although the post-antibiotic era is not upon us yet, this should be taken as a wake-up call to the world. There are many factors to be taken into account, such as the infection, the patient and whether there are alternative treatment options available, as combinations of antibiotics may still be effective.
A commentary in the Lancet concluded the implications of the aforementioned study are enormous and unless something significant changes, doctors would face increasing numbers of patients for whom they will need to say there is nothing which can be done to cure their infections.
Antibiotics are designed to kill or block the growth of bacteria, but not all bacteria are susceptible. Some are naturally immune. Resistance also arises spontaneously by chance mutations. Resilient strains can then multiply and thrive – overnight, one bacterium can multiply to become a million.
When the antibiotic of choice is given it kills the sensitive bacteria but any resistant ones live on. Resistance can also be passed from one species of bacterium to another.
In addition, the more an antibiotic is used, the greater the chance there will be that bacteria will develop resistance to it. Experts are concerned that antibiotics are being used inappropriately. Many are prescribed and used for mild infections when they don’t need to be. Antibiotics cannot help you recover from infections caused by viruses, such as common colds or flu.
Another issue is people who fail to take the whole course of prescribed antibiotic. Stopping treatment early means that the under-treated bacteria could turn resistant.
It is also thought that the widespread use of antibiotics in animals has led to resistant strains of some bacteria being transmitted to humans through food.
Experts are concerned that we are reaching a point where some previously manageable infections will become untreatable with antibiotics.
The superbug MRSA (Methicillin-resistant Staphylococcus aureus) is now resistant to so many drugs that it is already hard to treat. Recently, there have been reported cases of the sexually transmitted disease gonorrhoea that have been resistant to all the antibiotics normally used to manage the infection. We are seeing cases of multi-drug resistant TB and the emergence of threatening new resistant bacteria like New Delhi metallo-beta-lactamase (NDM-1).
Resistant bacteria are spread through direct contact with a person or animal with that infection in the same way that other bacteria spread. Resistance is a particular problem in hospitals and places like old people’s homes where many vulnerable people are gathered together. Increased international travel means people infected with resistant bacteria in one country can spread them to another country very quickly.
Pharmaceutical companies are placing renewed emphasis on the search for new antibiotics and are also developing new vaccines to prevent common infections. But these ventures are expensive to fund and in terms of cost-effectiveness for the company, may be less attractive than other business opportunities. Moreover, many of the newer antibiotics are chemical variants of older agents and this means resistance development can occur quickly.
If you are prescribed antibiotics by your doctor, make sure you complete the course even if you feel better because not taking the full course encourages the emergence of resistance. And, of course, they should only be taken when prescribed by a health professional. They do not work for viral infections, only bacterial ones.
Don’t share your antibiotics with anyone else. And remember that basic hygiene, such as hand washing and taking care when preparing food, can stop the spread of many bacteria, including some resistant strains.
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