The Rising Tide of Antibiotic Resistance

For the past 70 years state-of-the-art healthcare has been saving countless lives around the world. Since the discovery of antibiotics in the late 1920s, the era of Modern Medicine in which we live in has allowed us to live longer, happier and more fulfilling lives - but all of that could now be in jeopardy.

Theorised and pioneered since the 1880s "antibiotic chemotherapy" is the process in which a drug is used to specifically target a bacterial organism to combat or prevent an infection. Each antibiotic drug works by targeting specific receptor sites on the organism's cell membrane, and bringing about a series of changes that kills the organism. The most well-known antibiotic is Penicillin, discovered accidentally by Alexander Fleming in 1928 and still used today, although in less occurrence.

Before antibiotics many people had a much shorter life expectancy, dying from minor injuries and complications. The problems weren't the ailments themselves but the infections that injured and ill people were more prone to. To give an example, the first patient to be administered Penicillin was Albert Alexander - a British Policeman who was so ridden with bacterial infection that he could not be recognised by his family. His head was covered in abscesses, doctors even had to remove an eye, all because days before he had scratched his face on a rose thorn in his garden.

For the last half-century antibiotics have dissipated the number of deaths from infection. Antibiotic treatment is commonplace in healthcare and even considered the backbone of our medicinal practices. They prevent diseases, work alongside compromise immune systems, allow those who have undergone surgery or other treatments to recover faster and safer.
In the next 50 years, this could all be about to change due to antibiotic resistance.

All life on this planet has evolved to be where it is today, including bacteria. Unlike many multi-cellular organisms they evolve at a much faster, uncomparative rate. With every new generation mutations can occur - some of these bad, some neutral and some even advantageous - and with a generation time of around 20 minutes bacteria can develop (through a build-up of "accidental mutations") advantageous abilities within an extremely short period of time. When a bacterial organism develops an advantageous mutation to survive in the presence of an antibiotic drug it is said to be resistant.

Projections of Antibiotic Resistance

The main factor to address is that, if antibiotic resistance increases enough, many more people will die from infection. A study conducted by RAND Europe in 2014 showed that in the US and Europe 50,000 people die yearly from infections that no drug can help. This is mostly because the vast majority of antibiotics that we use belong to a generation of drugs that were made in the 1980s. The World Health Organisation predicts that by 2050 10 million people will die every year from antibiotic-resistance infection.

Bacterial disease may not just be caused by infections of infamous "hard-hitting" species, in fact a rise of resistance within many species of common bacteria that we live with would become deadly; potentially resistant infections like strep. throat and salmonella could mean death, as it did at the beginning of the 20th century.
Just a few months ago a senior medical official of the NHS reported to GPs that a super resistant strain of Neisseria gonorrhoeae had surfaced in England, meaning many of it's carriers could have a completely non-treatable Gonorrhoea infection.

A Provoked Resistance?

Nature will always find a way to adapt, so the evolution of bacteria to resist harmful drugs that they are being exposed to is inevitable. But that isn't to say that our practises have caused this rate of resistance appearance to sky-rocket.
As briefly mentioned, almost no new antibiotics have been discovered and approved since the 1980s. Back in that time, pharmaceutical companies believed that the various classes of antibiotic drugs were enough to tackle any infection for the foreseeable future. Since then only 1 effective antibiotic has been discovered, and it will not be available for the next 5 years (See Teixobactin). With no other new antibiotics in circulation, 30 years or so has been more than enough time for bacteria to develop a resistance to most of our antibiotic arsenal.

A linked cause (and potential reason) to the non-existing new generations of antibiotics is an economical one - many pharmaceutical companies do not see making new antibiotics a financially beneficial venture. This mainly because bacteria have began to evolve so quickly that it's not in their best interests to fund potentially new antibiotic drugs that could become inadequate in the next 10 years. The figure above backs up their opinions on the matter.

Fourthly, antibiotics are being abused. This is the broadest and most harmful cause of microbial resistance, and the misuse of antibiotics doesn't solely lie with human use.
In a society that relies on industrial farming, many animals are fed a variety of antibiotics on a daily basis. Rather than treating a present infection, most are said to be needed to increase the meat yield and health of the animal. Some antibiotics are even used on plant crops.

In the case of human medicine, is the general practice of some doctors is to prescribe a "shotgun" cocktail of antibiotics for a patient that may have not even been screened for any bacterial infection at all. The UK's National Institute for Care Excellence reported that last year 10 million antibiotics were unnecessarily prescribed - that equates to 1 in every 4 capsules.
The way in which we individually use antibiotic medication is often wrong too. Many people who are given a prescription stop taken it immediately after they start to feel better. In the case of antibiotics this is very dangerous as it gives the trace amounts of the infection left to adapt and grow, bringing back the infection and increasing the chance of this resistant colony to pass on it's genes to other bacteria in the environment.
Taking antibiotics incorrectly or even unjustifiably also harms your body flora - the "friendly" bacteria that live predominantly in your intestines and help you absorb nutrients from food.

What Could We Do to Slow Down the Rate of Resistance?

The easiest ways to tackle this problem are socio-economical. In the here and now, with no scientific development, governments could put pressure on Health services to scrutinise the ways in which antibiotics are prescribed. Institutional audits could question every decision as to whether a patient should be given antibiotic treatment - backed up by regular and commonplace patient screening tests to ensure an specific infection is present and has need for treatment. Changing the public attitude towards typical antibiotic use (targeted equally at non-western countries with less awareness of proper use) could prevent worried parents from demanding that their child has antibiotics for a non-credible, minor illness. These implementations could swiftly slow down the rate of resistance, and reserve many antibiotics for more effective uses in surgery, artificial replacement operations and for those with compromised immune systems.

Another way to look at the problem would be to devise alternatives to antibiotic treatment. Preliminary research into predatory bacteria is currently being conducted by the US Defence Advanced Research Projects Agency, which investigates whether species of bacteria could successfully kill other bacteria which cause infection in the human body.
Similar to antibiotics, genetically produced components in a cell - or peptides - with antibacterial activity have been isolated from several different organisms to see if they can be used pharmaceutically. One drawback to this approach is that just like antibacterial drugs, bacteria would eventually become resistant to many of these peptide drugs.

The most promising alternative to antibiotics is already used in many laboratories on tissue, and some have been trialled for therapeutic use in the past (In the Soviet Union, for example). Phage therapy involves a small virus that attack bacteria (a phage) being introduced into the body of an infected individual. The phage is genetically designed in a way that it should infect and kill the harmful bacteria and that bacteria alone. Progress to clinical trials has been reached in European health institutions although only for one particular treatment (an infection associated with burns).



In all, something has to be done to prevent the impending damages that antimicrobial resistance could cause to our modern civilisation. Since their discovery, these drugs have come with warning predictions from the very pioneers of the field - spelling out a disastrous post-antibiotic era.

"The thoughtless person playing with penicillin treatment is morally responsible for the death of the man who succumbs to infection with the penicillin resistant organism"

- Sir Alexander Fleming, 1946.

- Information researched from many sources, including Mary Mckenna's TED talk "What do we do when antibiotics don't work anymore?"
- Photo of resistance figures taken from M McKenna's TED talk "What do we do when antibiotics don't work anymore?"
- Photo of doctor prescription taken by Anthony Delvin/ PA
- Photo of phage and bacteria taken from http://www.foodsafetynews.com/2016/01/bacteriophages-an-old-antibiotic-alternative-becomes-   new-again/#.Vppc-9SLTIU
- other references http://www.theguardian.com/society/2015/aug/18/soft-touch-doctors-write-10m-needless-prescriptions-a-year-says-nice
- www.nature.com/news/antibiotic-alternatives-rev-up-bacterial-arm-race-117621