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The problem with antibiotics

6 min read
2 Nov 2018

We have all likely stumbled into our GP’s office at some point with a cold or infection that we just can’t shake, hoping antibiotics will help us get back on our feet. Many of us may not realise, though, that constantly using antibiotics may have unintended side effects.

In fact, the World Health Organization (WHO) now lists antibiotic resistance as one of the world’s biggest threats to our health.1 This means that treating bacterial infections with antibiotics is no longer as effective as it used to be.

What is antibiotic resistance?

Antimicrobial resistance (AMR) occurs when microorganisms, including bacteria, build resistance over time to antimicrobial medicines, like antibiotics.

Penicillin was the first modern antibiotic, discovered in 1928 by Alexander Fleming. By 1940, the penicillin discovery team had already identified a bacteria resistant to the antibiotic2.

Antibiotic resistance is a natural occurrence both with and without human action: some bacteria produce their own antibiotics to fight other types of bacteria3, and natural selection dictates that bacteria must evolve to face (normal, regulated) use of antibiotics. However, human misuse and overuse of antibiotics means that bacteria now have a much higher level of antibiotic resistance.

How does bacteria become resistant to antibiotics?

Antibiotics impose ‘selective pressure’4 on the target bacteria, forcing them to either adapt to the threat or die. The bacteria strong enough to adapt to survive has now acquired a resistance to the antibiotic it fought against and will go on to multiply, producing more bacteria cells with the same resistance.

We’re asking for more antibiotics and paying the price

In Australia, GPs are the biggest prescribers of antibiotics5, and it’s here that we can find some causes of antibiotic resistance. According to the Organisations for Economic Co-operation and Development (OECD), in 2015 Australians were prescribed antibiotics at a rate of 22.8 Defined Daily Doses (DDDs) per 1,000 people each day6. The OECD average is 20.6 DDDs per 1,000 each day.

Part of this increased prescription rate could stem from GPs who hesitate to refuse patients who are asking for antibiotics; doing so could threaten the doctor-patient relationship.7

Antibiotics only work on bacterial infections, not viral infections, like common colds, flu and other types of acute respiratory infections. In the early stages of one of these infections, it can be difficult to determine whether the cause is a simple virus or more serious bacterial infection, as they both have similar symptoms. As such, GPs often prescribe antibiotics8 as a way to prevent the infection developing into a bacterial one, or just in case it is a bacterial infection in the first place.

How could antibiotic resistance impact medicine and health?

Not only do antibiotics treat common bacterial infections, they are also vital to medical procedures like caesarean sections and organ transplants9. With antibiotic resistance on the rise, WHO are already starting to see common infections, like pneumonia, salmonellosis and tuberculosis, becoming more difficult to treat with antibiotics.10

The Australian Government predicts that more infections will become harder to treat and people may be sick with these infections for longer, requiring longer hospital stays, more expensive and complex treatments11. These treatments may include different antibiotics that may have harmful side effects for the patient.

In short, we could soon see a post-antibiotic era when simple infections caused death instead of a short illness.12

What are the authorities doing to improve such resistance?

WHO, in particular, are taking a stand against antibiotic resistance by introducing several strategies and campaigns designed to raise awareness of, and stop, antibiotic resistance. These include World Antibiotic Awareness Week every November, the Global Antimicrobial Resistance Surveillance System and the Global Antibiotic Research and Development Partnership.

The Australian Government has also stepped up to the mark in the fight against antibiotic resistance. In 2015, the Departments of Health and Agriculture and Water Resources released the National Antimicrobial Resistance Strategy 2015 -2019, a report with seven objectives aimed to reduce the misuse and overuse of antibiotics in Australian medicine.13

The government also conducted a trial in June 2017 aimed at reducing GP prescriptions of antibiotics.

The trial involved 6,649 GPs, all of whom had prescribing rates among the top 30% in their region. Of these GPs, 1,338 remained as the control group, and 5,311 were each sent one of four different letters by the Australian Chief Medical Officer. These letters reminded the GPs about the uses and outcomes of antibiotics and prompted them to consider their prescribing rates.

The trial’s results showed a significant drop in prescribing rates amongst the GPs who received three of the four different letters; one of those three letters saw a drop in prescribing rates of 12.3% over the six-month trial period.

 

How can we fight antibiotic resistance?

Fortunately, WHO has outlined a number of ways we can help combat the rise of antibiotic resistance. Firstly, the organisation suggests you follow your health professional’s instructions, both when using antibiotics and when they feel you don’t need any. Only use antibiotics when they have been prescribed to you, don’t share antibiotics with someone else, and don’t save antibiotics for later, as many Australians have been found to do.

WHO also recommends practising basic hygiene routines as a way to prevent contracting an infection in the first place. Washing your hands regularly, keeping vaccinations up to date, preparing food hygienically, practising safe sex and avoiding close contact with anyone who may be sick are all ways you can help fight both infections and antibiotic resistance.

BioMed Central (BMC) also suggests that you ask your doctors “some questions such as: what will happen if you wait and watch? How much benefit is there from antibiotics? And how much harm is there?”14

Sources
[1] World Health Organization – Antibiotic Resistance. February 2018
[2] Julian Davies and Dorothy Davies – Origins and Evolution of Antibiotic Resistance. September 2010
[3] Alliance for the Prudent Use of Antibiotics – General Background: About Antibiotic Resistance. Accessed October 2018
[4] Microbiology Society – Antibiotics. Accessed October 2018
[5] Australian Government – Nudge Vs Superbugs: A behavioural economics trial to reduce the overprescribing of antibiotics. June 2018
[6] Organisation for Economic Co-operation and Development – Health at a glance 2015. Accessed October 2018
[7] Australian Government – Nudge Vs Superbugs: A behavioural economics trial to reduce the overprescribing of antibiotics. June 2018
[8] Australian Government – Nudge Vs Superbugs: A behavioural economics trial to reduce the overprescribing of antibiotics. June 2018
[9] Australian Government – Nudge Vs Superbugs: A behavioural economics trial to reduce the overprescribing of antibiotics. June 2018
[10] World Health Organization – Antibiotic Resistance. February 2018
[11] Australian Government – How does AMR affect you? October 2017
[12] World Health Organization – Antibiotic Resistance. February 2018
[13] Australian Government – Responding to the threat of antimicrobial resistance. June 2015
[14] BioMed Central – Improving the conversation between doctors and patients about antibiotic benefits and harms for coughs and colds. October 2018

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Written by Eliza Buglar

Because she likes reading, as well as watching endless amounts of films, Eliza majored in Creative Writing and Film and Television at QUT. She also likes music, but didn’t study that. When she’s not using her writing major at Compare the Market, you can catch her utilising that film major at every Marvel and Star Wars film that comes into cinema.

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