The Growing Threat of Antibiotic Resistance
Antibiotics, hailed as one of the most significant breakthroughs in modern medicine, play a crucial role in treating bacterial infections. However, their effectiveness is gradually diminishing due to a concerning phenomenon known as antibiotic resistance. This occurs when bacteria evolve mechanisms to withstand the effects of antibiotics, making certain infections increasingly difficult, if not impossible, to treat. These so-called “superbugs” are responsible for thousands of fatalities each year, claiming around 35,000 lives annually in the UK and over one million globally.
Recently, a report from the National Audit Office highlighted that the UK is likely to fall short of several targets established in 2019 aimed at combating this issue. The goal was to reduce drug-resistant infections in England by 10% between 2018 and 2025; however, rates have instead surged by 13% as of 2023. This alarming trend raises the question: what can be done to reverse this situation?
Professor Stefano Pagliara from the University of Exeter explains that antibiotic resistance stems from the natural evolution of bacteria. These organisms have existed for billions of years and have developed sophisticated strategies to evade antibiotics, which are often derived from naturally occurring substances produced by other bacteria, fungi, or plants. “They are older and wiser than us,” Professor Pagliara notes, emphasizing the significant advantage bacteria hold in this biological arms race.
Compounding the problem, the production and unwarranted release of antibiotics into our environment have reached unprecedented levels, primarily due to their extensive use in both healthcare and agriculture.
Environmental Impact and Public Health Risks
Antibiotics and antibiotic-resistant bacteria can end up in sewage systems, subsequently contaminating rivers and other water bodies. Professor William Gaze, a microbiologist at the University of Exeter, warns that the concentration of antibiotics found in sewage and river water can pose serious risks. “In some cases, we can measure antibiotic levels in sewage or river water that approach concentrations where there’s a risk,” he stated.
When such resistant bacteria enter the human body, possibly through activities like outdoor swimming, they can establish colonies. Research indicates that surfers who frequent beaches contaminated with antibiotic-resistant E. coli, a fecal bacterium known to cause diarrhea, are more likely to harbor this superbug in their gut. While these bacteria may not cause immediate illness, they can lead to antibiotic-resistant infections in the future.
According to the National Audit Office, superbugs directly contribute to 7,600 deaths annually in the UK, with their overall impact resulting in 35,000 fatalities. Unfortunately, many individuals are unaware of this toll, as infections related to antibiotic resistance are often recorded under broader categories such as sepsis or pneumonia.
Sepsis poses a particularly urgent threat due to its rapid progression. If the first-line antibiotic prescribed by doctors proves ineffective, they will typically try a second option. However, this delay can be lethal in cases of sepsis, which can lead to organ failure within hours if not treated promptly. Professor Adam Roberts, a microbiologist at the Liverpool School of Tropical Medicine, highlights the dire consequences of untreated sepsis, stating, “You’ll have organ failure within hours if it’s untreated.”
Even in non-fatal cases, antibiotic resistance complicates the treatment of numerous medical conditions, resulting in increased suffering and disability. For example, individuals with diabetes are susceptible to foot ulcers due to poor blood circulation. If these ulcers become infected with antibiotic-resistant bacteria, amputation may be necessary. Similarly, patients enduring recurrent urinary tract infections may find themselves hosting superbugs within their bladders that prove impossible to eliminate.
Strategies to Combat Antibiotic Resistance
The UK government has initiated various strategies to address antibiotic resistance, as outlined in a policy paper released last year. These strategies encompass enhanced surveillance systems to monitor antibiotic-resistant infections, although many of these efforts may go unnoticed by the general public.
One prominent strategy focuses on educating both doctors and patients about the importance of avoiding unnecessary antibiotic use. The more frequently an antibiotic is prescribed, the greater the likelihood of resistance developing. A significant battleground in this effort is the prescription of antibiotics for coughs and colds, which account for six out of ten antibiotic prescriptions in primary care worldwide. Given that most coughs and colds are viral in origin—rendering antibiotics ineffective—this presents a critical area for intervention.
While NHS guidelines suggest that antibiotics may be warranted for severe symptoms, such as red and swollen tonsils or high fever, determining whether an infection is viral or bacterial can be challenging for general practitioners (GPs). Faced with uncertainty, GPs often err on the side of caution, influenced by patients who may insist on receiving an antibiotic prescription. Professor Alastair Hay, a primary care researcher at the University of Bristol, explains, “If there’s any doubt about whether a patient will benefit from an antibiotic, they will generally do what they feel is safest and prescribe.”
However, reducing unnecessary antibiotic prescriptions is beneficial not only for public health but also for individual patients. Research by Professor Hay indicates that individuals who have taken antibiotics are more likely to carry resistant bacteria for up to a year afterward. Thus, “there are definitely good reasons for individuals to be careful about taking antibiotics,” he advises.
Furthermore, since bacteria can spread among household members, it is essential to promote a culture of caution regarding antibiotic use among family members. Professor Roberts underscores the importance of this collective approach, stating, “If resistance exists within a particular individual, there’s a higher chance of it spreading within the household community.”
Addressing the Dwindling Pipeline of Antibiotics
While reducing antibiotic use is crucial, a long-term solution lies in accelerating the development of new antibiotics. The rising resistance of bacteria to existing medications necessitates the introduction of new treatments. Unfortunately, the number of new antibiotics entering the market has significantly declined since the peak discovery years of the 1950s through the 1970s. This trend is often referred to as a dwindling antibiotic pipeline.
This decline can be attributed in part to pharmaceutical companies shifting their research focus to more profitable areas, such as medications for chronic conditions like obesity or heart disease, which often require lifelong treatment. Moreover, if a company successfully develops a new antibiotic, healthcare systems may opt to limit its use to preserve its efficacy, which can create a paradox where new antibiotics remain underutilized.
To address these challenges, innovative strategies are being explored. One approach involves incentivizing pharmaceutical companies to return to antibiotic research by providing them with a guaranteed annual payment for new antibiotics, regardless of usage. NHS England initiated one such groundbreaking deal with Pfizer and Shionogi in 2022.
Another promising avenue is for governments and health organizations to fund antibiotic research conducted by academic institutions. Recently, three prominent health charities—the Gates Foundation, Wellcome, and the Novo Nordisk Foundation—announced a $50 million fund aimed at supporting such research.
While these strategies hold promise, they will require time to yield results. In the interim, the public can mitigate their risk by minimizing unnecessary antibiotic use, adhering strictly to prescribed regimens when antibiotics are necessary, and refraining from using antibiotics intended for others. Ultimately, as Professor Roberts emphasizes, one of the simplest yet most effective measures is practicing good hygiene. “Prevention of infection is probably the best thing that healthy adults and children can do,” he concludes.
