The war of the superbugs – time for a change in our antibiotic behaviour!

Back in 1928, Alexander Fleming made a breakthrough and discovered penicillin, the first antibiotic. But these drugs didn’t become widely available to treat bacterial infections until the 1940s. We’ve come a long way since then. Today we rely on antibiotics to save lives, using them to treat sepsis, tuberculosis, food poisoning, chest, urinary tract and many other infections. Antibiotics are also given during surgical procedures to prevent infection complications. They are used to help people undergoing organ transplantation and to protect those with weakened immune systems due to autoimmune diseases or chemotherapy for cancer.

But the world is reaching crisis point where antibiotics are concerned. The rise of bacteria capable of resisting their action is putting lives at risk. The World Health Organisation describes antibiotic resistance as one of the biggest threats to global health, food security and development. 

Why is antibiotic resistance a big problem?

As with any evolutionary process, it is survival of the fittest where bacteria are concerned. Over time, they adapt, change and mutate to protect themselves from dying at the hands of an antibiotic. These resistant bacteria ‘go forth and multiply’ and can pass their skills on to others. As a result, strains of bacteria are developing that are resistant to many of the antibiotics that we use today. And humans and animals can transmit these so-called ‘superbugs’ to each other. 

Implications include prolonged, or even impossible to treat, infections which can lead to more extended hospital stays, increased healthcare costs and even death. For example, multi-antibiotic drug-resistant typhoid, tuberculosis and gonorrhoea are already causing significant problems worldwide.

Towards the end of last year, the Organisation for Economic Cooperation and Development (OECD) estimated that resistant infections could kill 2.4 million people in Europe, North America and Australia by 2050 if we don’t start to tackle the problem. Looking very specifically at Swiss statistics, 270 people died in 2015 because of antibiotic resistance. 

What causes antibiotic resistance?

To think about solutions to the problem, we need to look at the reasons why this surge in antibiotic resistance has developed. It isn’t a new phenomenon but a fact of science that when exposed to antibiotics, bacteria will evolve and develop resistance over time. However, not using antibiotics correctly in humans and animals is accelerating this process. 

To start with, we must end the over-prescription and over-use of antibiotics. Taking antibiotics unnecessarily won’t make you feel better more quickly but will destroy the ‘good’ bacteria in your body needed for digestion, defence against infection and healthy living, encouraging antibiotic-resistant bacteria to survive and thrive. 

A study published in the Journal of the American Medical Association (JAMA) in May 2016 found that during 2010-2011, almost a third of all antibiotic prescriptions in the United States may have been inappropriate. And a Public Health England study found that this figure was as high as 23% in England between 2013-2015 with unnecessary antibiotic prescriptions for sore throat, cough, sinus and ear infections the worst offenders. 

Adding to this over-prescription of antibiotics, in 62% of countries globally, antibiotics are still available without a prescription. International travel and mobility also increase the problem. A person can bring antibiotic-resistant bacteria into the country, particularly if they were hospitalised during their stay abroad. 

How do we tackle antibiotic resistance?

Medical professionals need to take responsibility and only prescribe antibiotics when they are needed. Further development and availability of rapid, near-patient tests to check for bacterial infections during a consultation may help. Also, rather than prescribing antibiotics to begin straight away, perhaps increasing the use of ‘stand-by’ prescriptions to start if symptoms are not improving could be another tool. 

We also need to increase public awareness that antibiotics work against bacterial infections only and don’t kill viruses like the flu, the common cold virus and most causes of gastroenteritis. They also don’t kill fungal or parasitic infections. Most sore throats and ear infections are usually viral but occasionally bacterial. Even if they are bacterial, they tend to get better by themselves within seven days. Antibiotics generally make no difference in the duration of symptoms and have the potential to cause side effects such as diarrhoea. 

The overuse of antibiotics in agriculture since the 1940s is also a contributing factor to the resistance problem that we face today. In the past, antibiotics were given to livestock to prevent disease and promote growth – a practice banned in Switzerland since 1999 and since 2006 in the European Union. Poor food hygiene practices, infection control and sanitation are also contributing to the rise of superbugs globally. 

The Swiss Antibiotic Resistance Report published in 2018 showed that the message was starting to get across in this country. In 2017, there were 29 prescriptions of antibiotics per 1000 medical consultations compared to 34-40 per 1000 in the years 2006-2013. The use of antibiotics in veterinary medicine also halved in the ten years since 2008. 

This has partly been an effect of the StAR National Antibiotic Resistance Strategy, first launched in 2015. A new facet to the campaign, “Antibiotics: use wisely, take precisely”, was started in November 2018 to raise public awareness and includes TV spots, posters, online publicity and a dedicated website, also available in English: www.correct-use-of-antibiotics.ch 

The key messages from the ‘Antibiotics: use wisely, take precisely’ campaign 

If you are given antibiotics:

• Take them as prescribed – complete the course, even if you feel better.
• Don’t skip doses.
• Don’t share your antibiotics with others.
• Return packs that are partially used to your pharmacist. Don’t throw them out with your household waste as they may get into the environment causing contamination. 
• Never use leftover antibiotics.

And if you are not given antibiotics, essential things to remember include:

• This is for a reason. Antibiotics won’t fight viral infections and even if they are bacterial, many infections clear of their own accord.
• If you take antibiotics when they’re not needed, this can lead to antibiotic resistance and make it difficult to treat infections when required. 
• Some of the existing antibiotics have already lost their efficiency to fight specific bacteria.
• Antibiotics have side effects, and if used when not needed, these can outweigh the benefits – they can weaken essential bacteria in the body and support the development of antibiotic resistance. 

There is no doubt that antibiotics save lives, but we need to get to a point where we depend less on them. If we don’t act now, in the future, what starts as a minor infection or minor injury will undoubtedly lead to many deaths. 

About the Author

Dr Michelle Wright is a British-trained General Practitioner and Director of HealthFirst, providing dynamic First Aid Training and Health Education in English throughout Switzerland (www.healthfirst.ch).  She also has a regular radio show about health on World Radio Switzerland (www.worldradio.ch/healthmatters). 

Disclaimer: This article is for information only and should not be used for the diagnosis and treatment of medical conditions. All reasonable care has been taken in compiling the information, but there is no legal warranty made to its accuracy. Consult a doctor or other healthcare professional for diagnosis and treatment of medical conditions. Dr Michelle Wright or HealthFirst is not responsible or liable, directly or indirectly, for any form of damages whatsoever resulting from the use of the information contained or implied in this article.

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