Top ten facts about antibiotics and antibiotic resistance
14 November 2012
To mark European Antibiotic Awareness Day (EAAD) on November 18 Professor David Livermore, an international expert on antibiotic resistance and the HPA’s lead in this key area has devised his top ten facts about antibiotic resistance and antibiotics.
David’s top ten facts:
- Antibiotics revolutionised medicine.
- They make many different infectious diseases treatable and surgery much safer. Some medical procedures, such as transplants, would have been unthinkable without antibiotics as the risk of infection is too high.
- Antibiotics carry the seeds of their own destruction.
- Antibiotics kill sensitive bacteria whilst resistant ones, which arise naturally, survive to infect further patients. This is a great demonstration of Darwin's theory of natural selection, but one that creates problems for treatment.
- Some antibiotics have already been lost to resistance.
- Penicillin is no longer effective for staphylococcal wound infections, ampicillin (a form of penicillin) is no longer used for infections of the urinary tract and ciprofloxacin (a synthetic antibiotic) is now useless in treating gonorrhoea. Many more are under threat.
- New antibiotics are hard to find and to licence.
- From the 1940s to the 1990s the answer was to develop new antibiotics, but this development has slowed. New antibiotics are less profitable than treatments for chronic diseases, and much of the pharmaceutical industry now concentrates on other areas of medicine.
- We need to try to slow the selection and spread of resistance.
- That means not using antibiotics for common colds, which are viral infections and do not respond to antibiotics. It means using antibiotics better - the 'right drug, right dose, right duration'. It means preventing patients getting infected the first place - which includes everything from doctors washing their hands between patients to using condoms to stop the spread of resistant STIs.
- We have had successes.
- The number of cases of MRSA blood poisoning (bacteraemias) in English hospitals has been reduced by over 80 per cent since its peak early in 2003/4 largely by better infection control. New vaccines have reduced the number of bacteraemias due to Streptococcus pneumoniae, and particularly those due to resistant strains.
- The tide of war against resistance runs against us although we win some battles.
- Resistance is increasing in other pathogens, especially in those referred to as ‘gram-negative’ bacteria, which mostly cause infections in hospitalised patients. In the year 2000 two per cent of E. coli from bloodstream infections were resistant to cephalosporins (a group of antibiotics) and four per cent to ciprofloxacin (another antibiotic). These rates are now 11 per cent and 21 per cent respectively. This matters because infections with E. coli are common – these bacteria causes one third of all bloodstream infections, which number over 30,000 cases per year.
- We are now using our ‘reserve’ antibiotics.
- Rises in resistance like those seen for E. coli force doctors to use carbapenems, which were previously the 'reserve' antibiotics for use when other treatments had failed. But now we using carbapenems much more and are seeing the spread of resistance to them as well. This is due to enzymes that destroy carbapenems, called 'carbapenemases'. Bacteria with these enzymes cause infections that are very hard to treat.
- Some of the other reserve antibiotics that doctors are now forced to use are toxic or not very effective.
- You can still almost always find an antibiotic to treat any bacterial infection. But these are not ideal and cause other serious side effects or just aren’t as good at killing the bacteria. In severe infections, treatment has to start 'blind’ in that doctors don’t know what bacteria it is until they have identified it in the laboratory which can take two days. The more resistant the bacteria, the more likely the blind treatment will not work. Where there is blood poisoning (sepsis) that roughly doubles the risk of death, from 20 per cent to 40 per cent.
- We must rise to these new challenges.
- We can do this partly by 'antibiotic stewardship' which means getting the best out of the antibiotics we do have by choosing those most appropriate for the infection that are known to still be effective. To complement this we need good infection control, and to reduce the number of patients who get antibiotics when they don’t need them. New technological solutions are also needed with reinvigoration of antibiotic development and new diagnostic tests that will enable doctors to quickly identify which patients really need an antibiotic, and which one. This is key to much better-targeted antibiotic use in the future.
David said: “On European Antibiotic Awareness Day it is important for us to think about our attitudes towards antibiotics and how we use them.
“Over the last ten years or so there has been a major rise in the numbers of resistant bacteria and we cannot let this go unchecked. The fact that we are using our reserve antibiotics to treat some infections is of concern, as resistance is now increasing to them too.
“While disaster isn’t imminent just yet we do need to take action now to protect ourselves for the future.”
Notes for editors:
- More information about EAAD can be found here: http://ecdc.europa.eu/en/EAAD/Pages/Home.aspx/
- The BSAC Antibiotic Action campaign seeks to reinvigoration of antibiotic development, and is to be supported (http://antibiotic-action.com/wp-content/uploads/2011/06/ExecutivesummaryTheUrgentNeed.pdf)
- The Health Protection Agency is an independent UK organisation that was set up by the government in 2003 to protect the public from threats to their health from infectious diseases and environmental hazards. In April 2013, subject to the usual approvals procedures for establishing new bodies, the Health Protection Agency will become part of a new organisation called Public Health England, an executive agency of the Department of Health. To find out more, visit our website: http://www.hpa.org.uk or follow us on Twitter @HPAuk or ‘Like’ us on Facebook at www.facebook.com/HealthProtectionAgency
- For more information please contact the national HPA press office at Colindale on 0208 327 7901 or email email@example.com. Out of hours the duty press officer can be contacted on 0208 200 4400.
Last reviewed: 14 November 2012