By Violet Quinn
Cases of bacterial infections resistant to even the most reserved, ‘last resort’, antibiotics are beginning to surface in the UK. Without the development of new antibiotics to combat the antimicrobial resistant bacteria, it is not unreasonable to suggest that we might enter a post-antibiotic era in the near future.
This is problematic, as the development of new antibiotics is a task considered much easier said than done. Specific types of bacteria, particularly Gram-negative bacteria, have until recently remained susceptible to one of the last groups of antibiotics, known as the polymyxins. These are a relatively old class of antibiotics with potentially harmful side effects. Amidst the concerning resistance shown towards other classes of antibiotics, polymyxins have regained significant therapeutic importance; a notion that has been reinforced by the World Health Organisation (WHO). In 2012 WHO named colistin, a polymyxin antibiotic commonly revered by medical professionals, as one of the most symbolic options for the treatment of severely resistant infections, as “critically important… to human medicine”. However, with this came the global emergence of the improper use of such antibiotics.
It has since been determined that even the defences of colistin against Gram-negative bacteria have been breached; another win for antimicrobial resistance. Research developments made earlier this year have already identified a possible mechanism for colistin resistance in bacteria such as Escherichia coli (E. coli).
Due to the plasmid-mediated nature of this resistance mechanism, it is possible for the resistance to be passed between bacterial cells via horizontal gene transfer. The long-term implications of this are catastrophic. One of the last resorts of pharmacological treatment choices for patients suffering from severely antibiotic-resistant bacterial infections, could no longer be an option in the future.
How Large Is the Scale of the Problem?
Currently, at least 50,000 people die each year as a result of antibiotic-resistant infections across Europe and the United States alone. To make matters worse, no new antibiotic drug classes have been discovered since 1987.
This almost 30-year rift in antibiotic class discovery, alongside decades of antibiotic misuse in the healthcare and farming industry, has brought us to the dire, looming crisis that faces us today.
Why Is Development Progress So Slow?
In order to develop new classes of antibiotics, years of research must be devoted into not only the discovery of the new classes, but also the development of such compounds into suitable forms to enable therapeutic treatment in humans. With these aspects combined, the development process for a new antibiotic class from an idea to a form suitable for administration, can span well over 12-15 years.
Additionally, there is no guarantee that the research will ever be successful enough to make it through all of these stages.
With research time aside, antibiotic discovery is not deemed profitable by some pharmaceutical companies, due to the poor return on investment related to relatively short treatment schedules and the curative nature by design. Therefore, two of the biggest hindrances to new antibiotic discovery are time and money.
How Can We Prevent the Crisis?
While it is not possible to halt the development of antimicrobial resistance, there are a number of measures that not only healthcare professionals, but also members of the public, can take to help win back what seems to be a losing battle. By further improving prescribing guidelines in both primary and secondary care environments, such as GP surgeries and hospitals, increasing awareness of the problem and possibly providing extra training, healthcare professionals can work with the NHS and Public Health England to help reduce the number of inappropriately or improperly prescribed courses of antibiotics.
Members of the public are urged not to visit their GP expecting to receive antibiotics for maladies such as the common cold or flu and possibly stay at home when this diagnosis is suspected to prevent further spread to others.
It is also important that anyone receiving antibiotics from their GP or healthcare professional takes the full course as directed and does not stockpile incomplete courses of antibiotics for self-medication in the future.
Antibiotic Guardians – Get Involved
If you are a healthcare professional or a member of the public who wishes to help combat the antibiotic resistance crisis, get involved by becoming an Antibiotic Guardian today. During World Antibiotic Awareness Week (14-20th November 2016) Public Health England will be running a campaign to raise awareness for antibiotic resistance and anybody can make a difference, no matter how great or small. Join with Durham University School of Pharmacy and make your pledge alongside over 30,000 others at http://antibioticguardian.com/ to support your health and the health of others.
Photograph: Public Health England