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The Post Antibiotic Era Has Dawned

Oct. 5, 2016


Antibiotics have been one of the greatest success stories in medicine. However, bacteria are a rapidly adapting foe which find new ways to evade drugs. In 1945, while accepting a Nobel Prize for discovering penicillin, Alexander Fleming warned of a future in which antibiotics had been used with abandon and bacteria had grown resistant to them. That future has arrived and we are entering a post antibiotic era.

As we lose effective antibiotics infections we now regard as trivial have the potential to become fatal. An infected cut could lead to a limb amputation or even become life threatening, and an illness like pneumonia would again become a mass killer. Before the advent of antibiotics, more people died from bacterial infection than anything else on the planet.

Already 25000 people die a year in USA and an equal number in Europe, of infection that has become resistant to antibiotics. We see the problem here in Takapuna too. We have patients who carry MRSA, the superbug which is often harmless until we need surgery and then it kicks in preventing wound healing. There are patients who have had the misfortune to have required so many antibiotics that now there are no longer any that will fight their bacterial infections. The post antibiotic era has dawned.

The problem starts with overuse. Recent research by doctors at Harvard and Brigham and Women's Hospital found that the vast majority of antibiotics prescribed for sore throats and acute bronchitis—an infection almost always caused by a virus, not bacteria—are useless – and yet 2/3 of patients presenting with these infections get treated with antibiotics. Why??

Our doctors frequently discuss this very issue.

Medplus services a population of highly educated people. Everyone will have heard of the problems regarding antibiotic resistance and most will know that antibiotics are ineffective for most coughs and all colds. However, when we are unwell and tired or worried about our ill children, these arguments can seem academic and we just want to "try anything' to get better. The problems of antibiotic resistance fade in our minds and we focus solely on our immediate plight and lose perspective on how likely we are to get better without any intervention.

The Ministry of Health are very clear what role medical professionals need to take to protect our antibiotics. They ask us to prescribe antibiotics only when necessary, according to evidence-based guidelines. Sometimes that can be difficult when a patient with a self-limiting infection has an expectation of being given antibiotics. We challenge our Medplus doctors to always be responsible gatekeepers of antibiotics, and we challenge you, our patients, to question the need for antibiotics for coughs, colds, sore throats and sore ears.

It is not only human consumption of antibiotics that is causing this global problem. Routine use of antibiotics in farmed animals is a significant and worrying issue in its own right. Another political issue is the broken model of antibiotic research. No drug company wants to invest heavily in creating new antibiotics that the medical profession will be urged not to use to prevent resistance developing – it is much more lucrative to produce new anti-cancer drugs. Governments are going to need to fund this research if it is going to happen.

https://www.cdc.gov/drugresistance/

http://www.health.govt.nz/our-work/diseases-and-conditions/antimicrobial-resistance

https://www.theguardian.com/lifeandstyle/2012/nov/25/should-i-avoid-taking-antibiotics

http://www.choosingwisely.org/patient-resources/antibiotics