Monday, 16 November 2015

Antibiotics - 'Handle with Care' - Another Warning from the World Health Organisation (WHO)

Handle with Care is what scientists have been saying about antibiotics for the past 70 years.  Alexander Fleming, in 1945, had warned about misuse of antibiotics but it seems that nobody has been listening.  Slides 54 to 60 in my biography of Fleming describe how antibiotic resistance can arise.
Antibiotics are chemicals that are produced by living systems to defend themselves against microbes which work very hard and cleverly to develop resistance to such chemicals.  It is an ongoing battle.  Eventually antibiotic resistance will happen but it will happen much more quickly if we, the humans, provide the correct environment and incentives to the harmful bacteria.  And this is exactly what we seem to have been doing for the past 70 odd years. Irony is that we have more or less run out of new antibiotics which can be effective against a range of resistant bacteria.  Such superbugs have the potential to create havoc with no drugs available to control them.
The latest warning from WHO is strong and necessary, as were the past warnings which have gone unheeded.  Will it be any different?  I believe not.  The problem is the way human societies and organisations work - we have learnt to take a short term, local view of everything around us - fundamentals are disregarded - existing knowledge is ignored - we now listen to pseudo-scientists more than actual scientific advice which is at times not comforting enough and not always easy to understand.
The WHO report has attempted to find out why people (surveyed in 12 countries) abuse antibiotics and do not appreciate the dangers of antibiotic resistance.  Some of the findings are really shocking:
A. 64 percent of those surveyed believe wrongly that antibiotics can be used to treat colds and flu, despite the fact that the drugs have no impact on viruses.
B. 66 percent believe that there is no risk of antibiotic resistance for people who take their antibiotics as prescribed.
C.  44 percent thought antibiotic resistance was only a problem for people who take the drugs regularly, when in fact, anyone, of any age and anywhere, can get an antibiotic-resistant infection
D.  A third meanwhile believed it was best to stop an antibiotic treatment as soon as they felt better, rather than completing the prescribed course of treatment
E.  five percent of Chinese respondents who had taken antibiotics in the past six months had purchased them on the Internet, while the same percentage in Nigeria had bought them from a stall or hawker.
F.  In Russia, only 56 percent of those who had taken antibiotics in the past year had them prescribed by a doctor or nurse

My personal experience with antibiotic use in India agrees with these findings. One can go to a chemist, buy antibiotics and stop taking them as soon as one feels better.

The question is - why are people not better informed and understand the harm that misuse of antibiotics can cause in the long term.  There is a reasonable case of putting the blame on the medical authorities - after all it is their responsibility to inform, educate and monitor drugs.  It is only in the past 15 years or so that in the UK the General Medical Council (GMC) started asking GPs to be prudent about prescribing antibiotics.  GPs tend to be too lenient with patients if asked to prescribe antibiotics.  There is no evidence that the government has a serious programme of information/education about antibiotics highlighting the dangers of antibiotic resistance. 

PS:  Yesterday, we heard the news of bacteria that is now resistant to all antibiotics.  I reproduce a press report about this finding.  


http://www.bangkokpost.com/learning/learning-from-news/771496/bacteria-gene-in-china-resists-all-antibiotics


'Invincible' bacteria threatens global epidemic: study

Nov 19, 2015 
AFP News Agency 

Medicine's final line of defence against deadly disease has been breached, raising the spectre of a global epidemic, scientists say, after finding bacteria resistant to last-resort antibiotics

The discovery could herald a virtual return to the Dark Ages, with doctors unable to control common germs like E. Coli, rolling back centuries of medical progress.
NEW GENE MAKES BACTERIA INVINCIBLE
"These are extremely worrying results," said Liu Jian-Hua, a professor at China's Southern Agricultural University and co-author of a new study.  Liu and his colleagues found a gene, called MCR-1, that allows bacteria to becomeresistant to a class of antibiotics known as polymyxins, which are used to fightsuperbugs

The gene, which was detected in common but deadly bacteria such as E. Coli and K. Pneumoniae -- the cause of pneumonia and blood diseases -- effectively makes bacteria invincible

Most worryingly of all, the gene is easily spread from one strain to another, said the study, which was published in The Lancet Infectious Diseases journalprompting warnings they could have "epidemic potential".
UP TO NOW RESISTANCE ONLY THROUGH MUTATION
Until now, rare cases of resistance occurred only through mutation in individual organismsseverely limiting transmission

The World Health Organization (WHO) has already warned anti-microbial resistance may result in "a return to the pre-antibiotic era," where even small infections -- or cuts -- could prove to be fatal

The superbugs were detected during routine testing of pigs and chickens in southern China, where animals were found to be carrying bacteria resistant to colistin, a drug widely used in livestock farming. 

A team of researchers then examined E. Coli and K. Pneumoniae samples collected from pork and chicken sold in dozens of markets across four provinces

They also analysed lab results from patients at two hospitals in Guangdong and Zhejiang provinces

More than 20 percent of bacteria in the animal samples, and 15 percent of the raw meat samples, had the telltale mcr-1 gene. It was also found in 16 of the 1,322 specimens taken from hospitals. 

The lower infection rate among humans almost certainly means that the resistant bacteria passed from animals to humans, the study found.
CURRENTLY CONFINED TO CHINA, LIKELY TO SPREAD GLOBALLY 

It said that while mcr-1 was "currently confined to China" it was likely to spreadglobally

"This is a worrying report, as polymyxins are often the last resort antibiotic to treat serious infections," said Laura Piddock, a professor of microbiology at the University of Birmingham. 

"Equally worrying is that this type of resistance can be easily transferred between bacteria." 

Other types of drug resistance -- such as for tuberculosis -- show that "this likely paves the way for it to spread throughout the world," she added. 

Some 480,000 people contracted multi-drug resistant tuberculosis in 2014, according to the WHO. The disease killed 190,000 in the same year.
ANTIBIOTICS COULD SOON BECOME USELESS

Professor Timothy Walsh of the University of Cardiff, who collaborated on the study, told the BBC News website antibiotics could soon become useless. 

"If MRC-1 becomes global, which is a case of when not if, and the gene aligns itself with other antibiotic resistance genes, which is inevitable, then we will have very likely reached the start of the post-antibiotic era," he said. 

"At that point if a patient is seriously ill, say with E. Coli, then there is virtually nothing you can do." 

The study will renew debate about the use of colistin in animal husbandry,researchers said. 

"The finding that this type of resistance can be shared by different bacteria --irrespective of whether from food, an animal or a person -- is further evidence that the same drugs should not be used in veterinary and human medicine," Piddock said.
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