Dani Garavelli: Antibiotic battle begins at home

WE’VE all done it, haven’t we? Well, I have, anyway. To my shame, I’ve tried to wheedle anti­biotics for a sick child from a GP even though I’ve been told it’s probably just a virus.

Growing use of antibiotics has dented their effectiveness in some situations. Picture: Robert Perry

“Oh, but he’s been poorly for such a long time,” I’ve pleaded. “Couldn’t we see if it can be hurried along with a week’s worth of amoxicillin?” I’ve also failed to finish a course, out of carelessness. The symptoms have long gone and I’m up to my eyes and forget I’m supposed to be on medication. Then, weeks later, I stumble across the left-over pills and feel guilty.

Most of us born after 1950 take anti­biotics for granted. We’re too young to remember when a simple bacterial infection was a frightening prospect. Throughout our lives, most of what has ailed us, from coughs, sore throats and earaches to festering sores, has been easily remedied in a matter of days.

In we’d trot to the surgery with our list of symptoms and out we’d trot clutching yet another prescription for one of the wonder-drugs which rendered once-terrifying diseases such as scarlet fever harmless.

Cheap and effective, however, antibiotics have become victim of their own success. Dished out too liberally, their power has been diluted, and bacteria they were supposed to kill adapted and became resistant.

Last week, David Cameron spelled out in stark terms what we’ve all known for a while: the days we could rely on antibiotics to keep us safe are at an end.

I don’t know if he felt the hand of history on his shoulder or the chill breath of the grim reaper on his back when he warned we could be “cast back into the dark ages of medicine”, but no-one who heard him was left in doubt of the scale of the crisis sparked by the rise of the superbug or the enormity of the effort required to solve it. Playing on a 21st-century ­obsession with post-apocalyptic ­scenarios, he conjured up a future where once-treatable conditions would lay waste to populations and life-saving procedures such as hip replacements and chemotherapy would no longer be carried out. Imagine: a world where a blister or scratch could prove catastrophic, where a minor ear infection could leave you deaf, where more women die giving birth.

Of course, we were already aware of the dangers posed by antibiotic-­resistant superbugs. Ever since MRSA started claiming the lives of hospital patients in the early 1990s, they’ve been moving up the political agenda. More recently, we’ve seen the rise of C difficile and antibiotic-resistant strains of salmonella and E coli.

Cameron spelled out the urgency of our current predicament. Though the number of deaths from MRSA is subsiding, we are seeing the emergence of other superbugs such as a strain of Klebsiella pneumoniae which is resistant even to carbapenem, the antibiotic of last resort. In some countries, antibiotic-resistant strains of diseases such as typhoid, TB and gonorrhoea are proving increasingly difficult to treat with existing drugs. Yet most pharmaceutical companies are not developing new drugs because it is more profitable to produce them for chronic conditions than acute ones and because the use of any new antibiotic is likely to be rationed to lengthen its lifespan.

So great is the emergency, it cannot be solved by one country, but requires a global effort similar to that directed against smallpox in the 1970s. The difference is that smallpox could be tackled by mass vaccination and containment. Halting the rise of the super­bugs would require international agreements on the prescription of anti­biotics, their use in farming and hygiene in hospitals. All this in a world of increased political turmoil where some governments have little or no control over their populations.

There are some positive developments. Politicians are now talking about ways to encourage pharmaceutical companies to focus on developing new antibiotics. Suggested incentives include tax breaks and the extension of patents. Other scientists are looking at alternative therapies such as phages – naturally occurring viruses that kill bacteria.

Still, when you consider that, for the first time in history, medicine is moving backwards you can’t help but feel depressed. And the worst of it is we brought it on ourselves.

Alexander Fleming himself predicted misuse of antibiotics would lead to microbes developing resistance and, sure enough, the first evidence emerged within ten years of the wide­scale introduction of penicillin in the 1940s. Yet human arrogance and a sense of our own invincibility led us to ignore all warnings, to believe we would always stay one step ahead.

By pledging to lead the global effort to find new drugs, Cameron is doing his bit to highlight the problem, but his success relies on his ability to bring other countries along with him. In the meantime, it’s incumbent on all of us to be more responsible about our own antibiotic use.

Spurning the drugs for the greater good, while, in the US, more than £30 million of antibiotics a year is used in livestock production, may feel as pointless as sorting your newspaper and glass into separate boxes while multinationals continue to spew toxic fumes into the atmosphere. But, like climate change, the responsibility for the prevention of superbugs must start in our own backyard or medicine cabinet. With no obvious solution on the horizon, it must surely be time to swap the hubris for a curative dose of humility.

Twitter: @DaniGaravelli1