Apocalypse Now?

If you haven’t heard about the deadly Ebola virus, it is a human tragedy of incredible proportions, killing around 50% of those that become infected and at this moment there is no known cure.Scanning electron micrograph of methicillin-resistant Staphylococcus aureus and a dead human neutrophil

Currently the concerted efforts of the international community mean that there is a good chance that this epidemic can be contained. Our border agency and our hospitals have a well-developed plan to identify, isolate and treat any infected people that enter the UK. Well not so fast… In all the excitement over Ebola, the media has largely overlooked a much more dangerous threat to the lives of those living in the developed world. Two deeply disturbing reports have been published over the last 12 months concerning the evolution of antibiotic resistant bacteria.

In April 2014, the World Health Organisation produced its first global report on antibiotic resistance, revealing a “serious, worldwide threat to public health”. In the report Dr Keiji Fukuda, the WHO’s Assistant Director General for Health Security, states that “without urgent, coordinated action… the world is headed for a post-antibiotic era, in which common infections and minor injuries… can once again kill”. The USA Health Protection Agency, the CDC, produced a report in February 2013 highlighting a particular strain of bacteria that is now virtually immune to all known antibiotics; the Carbapenem-resistant Enterobacteriaceae (or CRE) family.

These bacteria used to be a normal part of a healthy digestive system, but if they spread outside of the stomach they can cause dangerous infections. CRE that enters the bloodstream kills roughly 50% of those infected – the same mortality rate as Ebola. The even more frightening thing about this particular bug is that it can “teach” other bugs to overcome antibiotics too. One example of this is the E. coli bacteria. E. coli is a common bug, both inside and outside of healthcare settings. It is the most common cause of urinary tract infections (UTIs) and thousands of people suffer from these every year in the UK.

Now experts tell us that CRE has been able to spread its drug resistance to some E. coli strains, creating the real possibility that aminor infection could now prove fatal. The WHO report goes further and covers emerging evidence that many common bacterial, fungal and viral infections are becoming immune to treatment with conventional medications. The report also points out that there have been few new antibiotics developed since the late 1980s. As bugs become immune to one group of antibiotics we have, in the past, had new drugs to replace the old – this is no longer the case.

The WHO estimates that drug resistant bacteria could account for an additional 25,000 deaths in Western Europe per annum. Whilst many of these deaths will occur within hospitals, affecting those already in poor health, there is growing concern that relatively minor infections could start to prove fatal. The main anti-biotic resistant bacteria within hospitals are MRSA (a wound and bloodstream bug), klebsiella (a pneumonia and bloodstream bug) and E. coli.

Outside of hospitals Streptococcus (pneumonia and meningitis), Salmonella (food poisoning) and Neisseria gonorrhoea are reported as having higher and higher episodes of failed treatment – especially in the developed world. Whilst on the subject of STDs – antifungals are also becoming less effective on candidiasis (thrush) and antivirals are starting to lose their effectiveness in the treatment of HIV. So, as a healthy university student in the prime of your life, you may have thought that none of this really affects you – a bit like Ebola. The bad news is that it really could.

So, what can be done about it? To some extent this is a problem of the developed world’s own making. Indiscriminate prescribing of antibiotics is thought to be a major contributory factor. Doctors have seen antibiotics as a panacea for all ills and prescribed them even when there is very little clinical indication to do so. The more the bacteria are exposed to these drugs the more chance they have to figure out ways of overcoming them. We have made it too easy for them to understand our weapons in this fight against infection and we are paying the price for this lax attitude.

So one way to combat the problem is to be much more selective on how antibiotics are prescribed. Giving them only when illnesses are very serious and there is clear evidence that the drugs can be of real benefit. Better prescribing by the medical profession is a high priority in healthcare systems across the world – and is one of the key actions recommended in the WHO report.

Individuals can also play a part by not rushing off to the doctor every time they sneeze. Some old fashioned remedies can be just as effective – and might be worth a try – you don’t want to know what my gran does with yoghurt but apparently it works! Also if you do have to take antibiotics – always finish the course, don’t drink alcohol when you are taking them and never pass any unused tablets onto anyone else. Other actions that might help in the fight against these superbugs include maintaining high standards of personal hygiene – not always high on the student agenda.

Dr. Alastair Turnbull, the Medical Director of York NHS Foundation Trust, has labelled drug-resistant bacteria as “an immediate concern”. According to Dr. Turnbull, “Already within the UK many hospitals and patients carry CRE, bacteria that are highly resistant and now almost impossible to eradicate. EU-wide this costs about €1.5 billion annually but the human costs are higher still. Such bacteria are present locally, thankfully until now in small numbers, and we can still treat infections promptly. But time is slipping… and all of us have a responsibility to do something about this – now.”

In your day-to-day life think: cleanliness! Prepare your food hygienically. Keep your intimate areas clean and practice safe sex. It may be a cliché but prevention of illness is a whole lot better than a cure – especially when there may be no cure.