There are few public health issues of greater importance than antimicrobial resistance (AMR) in terms of impact on our society. This is a global crisis. And no, I’m not being dramatic.
This may seem like a dull topic - but please read on.
While this is an issue far bigger than any one of us, we do have some control over it, if we each take responsibility and act now. By educating ourselves, and sharing information with our friends and family (and anyone else that will listen!), we are playing an important role that shouldn’t be underestimated.
The 14th-20th November is World Antibiotic Awareness week, so what better time to do your bit?! At the bottom of this article is a link to the Antibiotic Guardian website where you can take a minute to ‘pledge’ your support to protect our valuable antibiotics. Please also take a minute to share this article with someone that you think will learn something from it.
So, for those of you who are unsure, here's a little introduction to antimicrobial resistance, and also a really personal story that I hope will highlight to you how severe the problem is.
What is Antimicrobial and Antibiotic Resistance?
There are several types of microbe that can cause infection, including bacteria, viruses and fungi. These can be treated by antibacterial, antiviral and antifungal drugs, respectively. More broadly, these types of drugs are referred to as ‘antimicrobials’.
The term ‘antimicrobial’ is often used interchangeably with ‘antibiotics’, but it’s worth knowing that while all antibiotics are antimicrobials, not all antimicrobials are antibiotics.
We are so familiar with these wonder drugs that we take them for granted. We abuse them; patients and doctors alike.
The result? Microbes are becoming resistant to these drugs.
If bugs are not successfully eradicated by antibiotics, the bugs mutate, meaning that they will continue to survive against that antibiotic. They can then pass this genetic information to other bacteria (think of it like one bacteria educating another on how to resist antibiotics), and will also pass their resistant traits onto their offspring, creating a fully-resistant generation of superbug. This superbug can spread from person to person.
The Danger of Antimicrobial Resistance
Without effective antibiotics, many routine and commonplace treatments will become impossible or dangerous.
In a few decades, we may start dying from the most commonplace operations and ailments that have previously been treated easily.
A growing list of infections such as pneumonia, tuberculosis, UTIs, blood poisoning and STIs are becoming harder, and sometimes impossible, to treat as antibiotics become less effective.
But it’s not just obvious illnesses and infections that require antimicrobials; many medical procedures like setting broken bones, organ transplantation, c-sections, hip replacements, and even chemotherapy rely on access to antibiotics that work.
This quote that perfectly summarises the problem:
The time may come when penicillin can be bought by anyone in the shops. Then there is the danger that the ignorant man may easily underdose himself and by exposing his microbes to non-lethal quantities of the drug make them resistant. Here is a hypothetical illustration. Mr. X. has a sore throat. He buys some penicillin and gives himself, not enough to kill the streptococci but enough to educate them to resist penicillin. He then infects his wife. Mrs. X gets pneumonia and is treated with penicillin. As the streptococci are now resistant to penicillin the treatment fails. Mrs. X dies. Who is primarily responsible for Mrs. X’s death?
Amazingly, this quote was by Sir Alexander Fleming during his 1945 Nobel Lecture.
What caused this problem?
- Unnecessary prescription of antibiotics for viral infections, against which they have no effect
- Too frequent prescription of broad-spectrum antibiotics, in place of a better targeted antibiotic, as doctors rarely pursue more precise diagnosis
- Inadequate use of antibiotics by us, not respecting either dosage or duration of the treatment, which means that some of the bacteria may survive and become resistant
- The use of antibiotics in livestock. Globally, the vast majority of antimicrobial drugs are given to farmed animals. In the UK alone in 2010, a total of 447 tonnes were sold for animal use, of which 87% were used in food-producing animals. Often, they are used because they fatten animals up (likely by affecting gut bacteria that regulate various biological functions, something that, according to some books on my must-read list, can happen in us humans too)
And to make matters worse, no new class of antibacterial has been discovered for nearly 30 years.
In a large part, the issue of antimicrobial resistance is down to a misunderstanding of antimicrobials by our society.
People demand them for colds and flu, people look to them as first port of call or even a standalone treatment against things like acne, and people don't complete courses of antibiotics exactly as prescribed.
Just this week, I have heard several flippant comments such as 'maybe your body is immune to that type of antibiotic' (it's not your body, it's the bacteria themselves) and 'it's a low dose of antibiotics so it'll give the bacteria chance to become sensitive again' (quite the opposite...).
Also this week, my boyfriend was prescribed broad-spectrum antibiotics during a sub-one-minute phone call with a doctor. No questions, no observations, no tests; no wonder we have this problem. Actions like this by doctors only perpetuate misunderstanding and carelessness by patients.
All of these things represent society’s inability to see the bigger picture.
But I get it; understanding the bigger picture is hard. It's hard to comprehend all of the billions of pounds spent on healthcare and all the extra lives lost, it seems like a very vague problems that only people of the future will have to deal with.
So here's my very personal story that I hope will bring it home...
How Antimicrobial Resistance Affects Me - A Personal Story
I have Cystic Fibrosis (if you don’t know what that is, read here) and have experienced first-hand the honestly hideous ordeal of trying to treat an antibiotic resistant infection.
Lung infections resistant to antibiotics often are deadly for people with cystic fibrosis. About 80 percent of cystic fibrosis patients have at least one antibiotic-resistant infection in their lungs by age 18 .
When I was 20, doctors found a highly multi-drug resistant bacteria in my lungs during a routine check. I wasn’t unwell at the time and even the doctors were shocked to have discovered it. Yet, to prevent lung damage, it was advised that I undergo intense antibiotic therapy to try and eradicate this bacteria before it started to cause severe problems.
I spent three weeks in hospital on intravenous (IV) antibiotics. The worse thing about it was that I was healthy and fit when I went into hospital, but by the time I came out, I felt sick from the drugs, had terrible sleep quality, hadn’t exercised and hadn’t eaten many nutritious meals. This was followed by 18 months of tiring at-home treatments. The doctors couldn’t even be sure that this treatment was successful.
Worse still, if I were to need treatment for this bacteria again now, six years on, I would need stronger, more aggressive drugs, and a longer cycle of IV antibiotics. Ideally, 2-3 months, but ultimately it would be ‘as long as it could be tolerated’, which gives you some indication of the strength of the drugs and their horrible side effects. Doctors say it would feel as bad as having chemotherapy. Still, they say there's only about a 30% likelihood that the bacteria would be eradicated.
In fact, new research has come to light in just the last few days that shows that shows just how aggressive this superbug is. Click here to read a short article about it on The Huffington Post.
I hope it will never come to the point where I need that treatment. That’s why I do what I can to stay healthy, although it always feels like I could be doing better - training more, pushing myself harder, eating better, doing more physiotherapy sessions… but that’s a topic for a different day.
This goes to illustrate the horrible reality of antibiotic resistance. The cost of health care is greater due to a longer duration of illness, longer duration of treatment, more expensive drugs, and additional medical tests. And you know what? It’s scary.
How you can make a difference
- For infections that your body can fight off on its own, like coughs, colds, sore throats and flu, try treating the symptoms for five days under guidance of a pharmacist rather than going to the GP
- Always complete a full course of antibiotics when prescribed by your GP
- If you do happen to have any unused antibiotics, always take them to your pharmacy for safe disposal to prevent them getting into the environment
- Wash your hands properly - for at least 30 seconds
- Get a flu jab. (I had mine at my local Boots store)
- Stop demanding antibiotics. Many people seem to feel that they haven’t been adequately treated if they don’t come away from a GP appointment with antibiotics, but accept that antibiotics are not necessary in many cases
- Request more specific tests from your doctor if possible, to ensure you get a target antibiotic where one is needed
These things are simple to implement, costing nothing but perhaps a few extra seconds at a sink, but rely on compliance from everyone in our society.
Where can you learn more?
Short on time? Watch and share this short video for a recap on antibiotic resistance + what you can do about it:
A couple of months ago, BBC aired a show called The Doctor Who Gave Up Drugs, in which Dr Chris van Tulleken (in the video above) takes over part of a GP surgery and stops patients' prescription pills as a kind of social experiment. I was so pleased to see this issue get a spot on TV. If you didn’t catch, it’s worth buying the download or finding it online.
Get your hands on The Drugs Don't Work: A Global Threat, a book by Professor Dame Sally Davies, the UK’s Chief Medical Officer. At a mere £3.99, and a quick and easy to read 80 pages, this is a great way to learn more about the different types of antimicrobials and how they work, as well as a little history around antibiotics, and how things are set to progress in the future.
Take this quiz
This speedy 5 question quiz from the Public Health England is a great way to test yourself, your friends and family on the topic of antibiotic resistance, while helping PHE assess awareness on antibiotic resistance across the UK.
Become an Antibiotic Guardian
Through the Antibiotic Guardian website, run by Public Health England, you can choose one simple pledge about how you’ll make better use of antibiotics and help save these vital medicines from becoming obsolete.
Did you already understand the huge problems that we face with antimicrobial resistance, or have you been affected by it? Leave me a comment below, or tweet me @theblondeethos to let me know.
Please share and spread this message of huge importance!