Originally published in Crikey.com.au on Friday, 14 September 2012.
The age of effective antibiotics is threatened by everyday farming and medical practices, sending us into what experts are calling a “death spiral”.
Dr Margaret Chan, the director-general of the World Health Organisation, called for health organisations to recognise drug resistance as a “serious, growing and global threat to health”. If left unacknowledged by the wider community, she believes that “things as common as strep throat or a child’s scratched knee could once again kill”.
The concept of Antimicrobial Resistance (AMR) is simple: what doesn’t kill bacteria will only make them stronger.
Professor Peter Collignon, the infectious diseases expert from Australia National University, was frustrated by AMR’s growth. “I find it very irritating because it’s so needless and it’s caused by stupidity … the consequences are a higher morbidity rate, more hospital beds taken up longer and soon we won’t be able to do much for simple infections. If this goes on, one day we might not be able to do major surgery or treat leukaemia,” he said.
Food manufacturing is one of the biggest sources of AMR with 80% of the world’s antibiotics used on food animals causing fast global distributions of infections such as E. coli and golden staph, which are increasingly resistant to drugs.
“Half of these infections in China and India are now untreatable because they can’t afford the antibiotics that the bacteria aren’t resistant to,” professor Collignon told Crikey.
The problem is exacerbated by people taking antibiotics inappropriately, sometimes for problems that antibiotics are not effective against such as viruses. He estimated that half the antibiotics prescribed in Australia are not necessary. In some cases, medicine and antibiotics are given out simply to appease demanding patients. Even when prescribed correctly, patients who don’t finish their course of medication over the recommended period pose the same risks to themselves as going to a more incompetent doctor.
For example, tuberculosis was once a disease most likely to be contracted in patients with HIV/AIDS but is now common to the general population. These days, multidrug-resistant tuberculosis can vary from patient to patient. Those with this strand have little more than a 50% chance of survival and more than 150,000 people die from it every year.
What’s more, finding replacement drugs that the bacteria aren’t resistant to is not always a viable option.
“Some experts say we are moving back to the pre-antibiotic era,” explained Dr Chan. “No. This will be a post-antibiotic era.”
According to professor Collignon, antibiotics was “the wonder drug of the 20th century because it doesn’t control your illness, it cures it”. But because of the cost of development, pharmaceutical companies have little incentive to create new ones.
In the US, drugs can take 12-15 years before being approved for the markets. A report by the Californian Biomedical Research Association found only 10% of preclinically tested drugs ever make it to human testing and only a fifth of those drugs make it to the pharmacy counter.
“But it’s not just about making new ones,” explained professor Collignon. “It’s about preserving the ones we have and preserving the health system that we have. Prevention is better than cure.”
He called for Australians to use common sense by washing their hands. When travelling to Third World countries, eat safe foods such as hot, cooked meats and drink boiled or bottled water. But the most basic step to prevention is only taking antibiotics only when needed.
“Talk to your doctor about it,” advised professor Collignon, “or before taking antibiotics, ask yourself, ‘Do I need this? Will this make much difference in my recovery’? In most cases, the answer is probably ‘no’. You won’t only be protecting yourself but you’ll be protecting your friends and family.”
He then applauded Australia on its superior water supply, its ban on raw meat imports and its prohibition on some antibiotics typically used on farm animals overseas. Eating local produce not only supports Australian farmers but is likely to suppress AMR as well.
Finally, Dr Chan remarked that despite the pressing need to address the issue, global awareness is undermined by other dominating concerns: “In my personal view, one problem is that the threat of antimicrobial resistance is competing for attention in a world beset by one global crisis after another. These days, doomsday scenarios are a dime a dozen.”
Feature picture credit: umanitoba.ca