Article by: Ed Siegwart
European Antibiotic Awareness Day (EAAD) took place on 18 November, in the middle of World Antibiotic Awareness Week and reminded us of the shocking statistic that if no new antibiotics are successfully developed then 10 million people will die of bacterial infections in 2050, and each year after that – we still are facing this terrifying statistic if new antibiotics are not developed.
Use of antibiotics
Antibiotics aren’t just for treating infections. They are given to cancer patients, HIV sufferers and other immunocompromised patients to prevent complications during their primary treatment. Antibiotics are also given to the majority of patients before surgery, to prevent them getting a potentially lethal infection; without them surgery has to be carried out under even more tightly controlled circumstances, and even then patients remain highly susceptible to post-operative infections. They are also given to expectant mothers before childbirth to prevent post-natal infections.
Antibiotics are a modern medical miracle, because they cure the diseases they treat. Tuberculosis, gonorrhoea, strep throat, chest infections, boils, acne, wound infections, stomach ulcers, diarrhea, tooth abscesses, pneumonia, scarlet fever, anthrax, plague, mastitis and styes, to name a few, are all curable thanks to these ‘magic bullets’.
However, antibiotics have stopped working. Bacteria have evolved ways of coping with antibiotics, and we are helping them. In the past, Doctors overprescribed antibiotics, or issued them when not required; the more we use them, the quicker resistance occurs. Patients do not always finish the full course of antibiotics they are given, actively selecting for, and encouraging the survival of resistant bugs. Significantly, despite clampdowns and better awareness of the problem in recent years, antibiotics are still being used as a growth promoter in animal farming, increasing resistant bug numbers, which then move into the environment and humans. These are just a few ways we are spoiling the pot.
The antibiotic industry has woken up to the danger, and is kicking into gear, but new drugs will not reach the market for 10-15 years. Even when a company bravely dips its toe into the market to produce a new drug, there is an incredible rate of attrition to make it through clinical trials, and drugs which start development rarely make it to market. The easy to make, easy to develop drugs have already been made, and the bugs are already resistant.
Progress with antimicrobials
We are still awaiting good news, although progress is being made behind the scenes. We still have a shortfall of new classes of antimicrobials to tackle the most resistant and most dangerous pathogens. The lowlight of the year was the announcement of the identification of mcr-1 in pigs in China, which has now been found globally. This gene confers resistance to the last line antimicrobial colistin, and with that, we are now living in a world where some infections are untreatable. This, added to the publication of a case study in the US of a woman who died after becoming infected with a strain of K. pneumoniae resistant to all 26 antibiotics which could possibly be used to treat it (I’m confident that this is only the tip of the iceberg), means the fabled post-antibiotic era has arrived.
Infections caused by the multidrug resistant strains of bacteria are still rare. However, they are sharply increasing and, as illustrated by mcr-1, spread rapidly.
What can we do to help with antibiotic resistance?
- When offered antibiotics, ask why they are being prescribed to you, and ask if you would get better without them. Often the answer is that ‘yes you will get better’, and they are only being offered ‘just in case’. In those circumstances, you might want to consider saying ‘no thank you’, to preserve these drugs for when we really need them, or more likely, for when your children need them.
- Make sure you are aware of the facts. LGC held the Great British Tea Party to raise money for Antibiotic Research UK, which raises awareness of the issues surrounding antibiotic resistance, and works to develop new treatments.
- Tell everyone! If we can continue to raise awareness among the general public, then the message will spread and we can better tackle the problem – because it is all of our problem.
Discovery and development of antimicrobials
LGC works to support the antimicrobial drug pipeline, from high throughput screening and drug development to clinical trial support and on into surveillance. Our experts work to guide compounds through the process, gathering data on MIC, time-kill, drug activity and other antimicrobial efficacy tests, to identify lead molecules and target organisms.
To find out more, please view our webinar on “In Vitro Antimicrobial Efficacy Testing: Potential Pitfalls and Future Methods”, where Ed Siegwart, Senior Scientist at LGC, discusses current testing methods being carried out at LGC and the ‘Next Gen’ methods in development, which will be used in the detection of AMR.
Article by: Ed Siegwart