Misuse threatens antibiotics effectiveness

Antibiotics have been a miracle of modern medicine. From a chance finding in 1928 to the modern day, millions of people have benefited from these life-saving medicines.

This week, the world marks World Antibiotic Awareness Week – both a celebration of the remarkable contribution that antibiotics have made to global public health and a clarion call to action to ensure their continued usefulness.

The case for a clarion call is clear: overuse and misuse of antibiotics in humans, animals, and the food production industry has seen bacterial resistance to antibiotics surge in recent years.

Without antibiotics, treatments that we take for granted for common diseases such as pneumonia or urinary tract infections will be lost. Effectively, we are seeing the end of modern medicine slowly being played out.

But we can act together to alter the situation.

How it works and why it matters

Humans and bacteria are symbionts – we live in close physical association, to the advantage of both. Every human is host to trillions of bacteria that live in our gut, on our skin, and in other body areas. Some of these bacteria are naturally able to resist the action of one or more antibiotics through specific resistance mechanisms they possess, and thus have a survival advantage.

Without antibiotics, treatments that we take for granted for common diseases such as pneumonia or urinary tract infections will be lost.

When an antibiotic is taken, these resistant bacteria survive and, given the right conditions, can cause an infection or can be transferred from our body surfaces to other people, particularly in health care settings where hand hygiene practices may be sub-optimal. This may in turn cause an antibiotic-resistant bacterial infection in a susceptible recipient.

There are momentous consequences for global health from worsening of bacterial resistance. The massive burden of bacterial infections in Africa means that we, and other low-resource regions, bear the brunt of infection, antibiotic use, and thus antibiotic-resistant infections.

In the course of my daily practice as an infectious diseases specialist, and that of many colleagues in African countries and across the globe, it is now routine to deal with bacterial infections that require an antibiotic of last resort. And it is increasingly common that we are faced with untreatable bacterial infections in our hospitals, where radical, extreme measures – such as amputation to control untreatable joint infections – are required to save lives. For some, there is nothing that can be done.

Unchecked antibiotic resistance has greater social consequences over and above just health. For example, by 2050 high antibiotic resistance is projected to drive an additional 28.3 million people into extreme poverty. The vast majority (26.2 million) would live in low-income countries.

This is because antibiotics are crucial in preventing and treating bacterial infections in the most vulnerable populations such as young people, the elderly, and those whose immune systems are unable to control bacteria. These include HIV-positive people, people with malnutrition, and those undergoing cancer treatment.

What can you do?

Antibiotic resistance is a universal issue. Although it is predominant in hospitals, bacterial infections in the community are also increasingly antibiotic-resistant. That means it affects everybody, crossing social boundaries and ignoring whether people are being cared for in public or private health care facilities. It is also happening in real-time.

Importantly, there is hope for the future if we commit ourselves as a global collective to intervene, change behaviours and focus our efforts.

The massive burden of bacterial infections in Africa means that we, and other low-resource regions, bear the brunt of infection, antibiotic use, and thus antibiotic-resistant infections.

First comes building awareness. If this article has piqued your interest, there are a multitude of resources out there to help explain the situation in simple terms, starting with the World Health Organisation (WHO) and Centers for Disease Prevention and Control websites, among others.

Second, protect yourself and your family by preventing infections in the first place. You can do this by ensuring all vaccinations are up to date and that you follow good, basic hygiene to prevent bacterial infections, including good hand hygiene.

Lastly, be appraised of how antibiotics work. For example, it’s important to appreciate that they will only treat bacterial infections. Antibiotics do not work against viral infections such as the common cold, most coughs, and the vast majority of cases of diarrhoea. They are of no help for general headaches, rashes or body aches. If you have a cold or flu, see your local pharmacist for advice on treating your symptoms. The illness will get better on its own.

Every time you take an antibiotic that is not needed, you compound the problem for yourself, your family, and everyone else. You also put yourself at risk of needless side effects of the antibiotics.

Only use antibiotics that are prescribed by a health care professional, and do not keep unused antibiotics for another occasion or share antibiotics with anyone else, which could harm them. Use antibiotics as directed by your health care provider.

Millions of dollars are being invested in reinvigorating an antibiotic pipeline that had dried up. This is also bringing hope of new antibiotics for the future.

But it doesn’t address the urgent need, here and now. We need to stand up together as a united voice, and become guardians of antibiotics to protect their future use.

Marc Mendelson, Professor of Infectious Diseases, University of Cape Town.