Antibiotics; A journey from good, to bad, to ugly

As I hope you are already aware, medicine is facing a crisis at the moment which could prove to be a bigger killer than cancer; antibiotic resistance. Bacterial infection seems an archaic issue, one that we solved years ago and have since forgotten as a major threat to human health in the public eye, but it’s making a comeback. Before we get into all that, however, let’s first look at what antibiotics are and how they came about in the first place.

Antibiotics are a group of drugs which can treat or prevent bacterial infections by inhibiting or stopping the growth of bacteria. There are hundreds of different antibiotics in circulation today, but they all stem from just a few drugs so can be categorised into six groups. One of these groups are the penicillins, which include the drugs penicillin and amoxicillin and this is where the antibiotics’ journey begins. Penicillin was discovered in 1928 by Alexander Fleming and is generally thought of as the world’s first antibiotic. Its initial discovery is quite well known, with Fleming accidentally uncovering the antibacterial properties of a mold called Penicillium notatum when returning from a holiday to find that where the mold had grown, normal growth of Staphylococci was prevented. Fleming then grew some more of the mold in order to confirm his findings; he had discovered something that would not only prevent growth but could be harnessed to fight bacterial infection, changing the world in its wake. However, Fleming didn’t develop Penicillin into what it is today. To do this, the active ingredient would need to be isolated, purified, tested and then produced on a grand scale.

It was 10 years later that endeavours into this began, when Howard Florey came across Fleming’s work and began further developing it with his team at Oxford University. Florey, and one of his employees Ernst Chain, managed to produce penicillin culture fluid extracts. From this, they experimented on 50 mice that they had infected with streptococcus and treated only half with penicillin injections. Whilst half of the infected mice died from sepsis, the ones which had been treated survived thus proving the effectiveness of penicillin. In 1940 the first human test was conducted, with injections being given for 5 days to an infected Albert Alexander. Alexander began to recover, but unfortunately Florey and Chain didn’t have enough pure penicillin to completely treat the infection and so Alexander ultimately died. This was now their biggest problem; making enough penicillin. It took 2,000 litres of culture fluid to extract enough pure penicillin to treat just 1 human case, so you can see how treating an entire population would frankly be impossible if they continued in this way. It was in the US whilst Florey and Chain were looking to find a solution to this problem that they happened upon a different, more prolific fungus called Penicillium chrysogeum. This yielded 200 times more penicillin than the previously used species, and with a few mutation-causing X-rays yielded 1000 times more. This allowed for 400 million units of penicillin to be produced for use during the war in 1942, reducing death rate from bacterial infection to less than 1%. And so began the antibiotic revolution in medicine which changed the world into what it is today.

Now, over 70 years later, we’re faced with a huge issue. Bacteria have become resistant to antibiotics due to their overuse. Antibiotic resistance occurs when a bacteria mutates so that the antibiotic can no longer kill it, and is part of natural selection. However, from previous knowledge of natural selection you might know that it is slow process across many generations and relies on the mutation being an advantage in order for it to become widespread. Yet when you use antibiotics rather than having 1 mutated bacteria amongst millions of non-mutated, all non-mutated bacteria are killed leaving a 100% resistant population. Albeit that population is exactly 1, but bacteria can multiply and start causing havoc very quickly. And then those same antibiotics no longer have any effect on the new culture, leading to longer hospital stays, more expensive medication and increased mortality rates.

Given how easily everyone is now able to travel around the world, this issue is not just localised to 1 country or continent but is on global scale. Given that tackling antibiotic resistance requires investment into finding new antibiotics and using the more expensive medications that are on hand, developing countries could be hit much harder than developed. Meanwhile, our struggling NHS will experience even more pressure as patients have longer stays at hospital. Worst-case scenario, if this issue isn’t addressed we could be returned to a time before antibiotics where common infections are once again fatal, killing 10 million people a year by 2050. Clearly not a desirable outcome, so how can we tackle antibiotic resistance?

Prevention and control of antibiotic resistance requires change at several different levels of society. The World Health Organisation has made recommendations for what we as individuals, healthcare professionals, policy makers, and people in the agriculture sector. Amongst the advice for individuals is not sharing leftover antibiotics, not demanding antibiotics if they aren’t considered necessary and preparing food hygienically to prevent infections. Meanwhile the healthcare industry needs to invest in research into new antibiotics, as so far most drugs being developed have only been modifications to existing antibiotics. They don’t work for long, and of the 51 new antibiotics currently being developed only 8 of them have been classed by WHO as innovative and capable of contributing meaningfully to the issue.

Research into new drugs is of the utmost importance, but the responsibility appears to fall to governments to fund such research as pharmaceutical companies are reluctant to do so. Some suggest that this is because it is more lucrative for drug companies to treat chronic conditions in which patients rely on their drugs for a lifetime than providing short-term (and may I point out, life-saving) treatments. Thankfully, this year countries including Switzerland, South Africa and the U.K. pledged a combined $82 million to support the Global Antibiotic Research and Development Partnership which was set up by WHO and the Drugs for Neglected Diseases Initiative. Less encouraging, is the estimation by the director of the WHO Global Tuberculosis Programme that more than $800 million is needed annually to fund research into new anti-tuberculosis medicines.

I know. It’s feeling dismal. But what can we do, on the metaphorical shop floor? Stop the overuse of antibiotics, follow through on any prescribed courses of antibiotics even if you’re feeling better and make other people aware of the issue. The bigger the issue becomes in the eyes of the public, the better the government and other organisations will address it so talk about it to anyone who will listen! I am optimistic that we as a species will survive this most recent challenge to our health, but only if we start pulling up our socks and addressing the situation.

 

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