Antibiotic-resistant diseases are a potential crisis

Antibiotics are vital in the fight against harm due to infection, yet this essential treatment option is increasingly under threat from growing numbers of antibiotic-resistant strains of bacteria.

Margaret Chan, director general of the World Health Organization, recently warned that some bacteria are becoming so resistant to common antibiotics that we could soon see “the end of modern medicine as we know it”.

‘If this issue is not tackled collectively, life-threatening infections will be difficult or even impossible to treat in the future’

With this ubiquitous and crucial weapon increasingly under threat, it is imperative that action is taken now to protect it against further risk in the future.

WHO has found that for people who succumb to some drug-resistant pathogens, risk of mortality is increased by approximately 50 per cent. Even though it is recognised across the globe that antibiotics are overused and all too frequently incorrectly administered, little is being done on a collective basis to tackle this world issue.

As a result of overprescription, inadequate treatment due to poor drug selection, and incomplete courses of antibiotics, bacteria have grown increasingly resistant.

Strong stewardship essential

To prevent the complete loss of our first-line antimicrobials, greater stewardship of antibiotics is essential by healthcare managers, professionals and other users worldwide, such as the agricultural industry.

If this issue is not tackled collectively, life-threatening infections such as sepsis, where broad-spectrum antibiotics are relied upon to work against a wide range of bacteria, will be difficult or even impossible to treat in the future.

While the issue of antibiotic resistance is typically perceived as one only relating to the medical world, rising antibiotic resistance in the wider natural environment also presents its own issues and contributes significantly to the issue of resistance in humans.

Soil samples over the past 68 years indicate a rise in background levels of antibiotic-resistant genes and the agricultural, veterinary and food sectors together account for half of all antibiotic use in the UK.

‘Using antibiotics more prudently worldwide is the most viable solution in fighting the war against sepsis’

Nonetheless, the use of antibiotics in healthcare is under more direct control. While initiatives have been undertaken within hospital environments to promote careful stewardship of antibiotic prescription, this has been mainly targeted at the doctors and pharmacists, and such stewardship is not widely practised outside hospitals.

The impact of sepsis

Sepsis is one of the most common deadly diseases worldwide, killing approximately 1,000 people globally every hour. According to a report by Public Service Review: UK Science and Technology, the disease costs the NHS more than £2.3bn a year.

While sepsis must be treated with early identification and control of the source and administration of antibiotics, there is an increased risk of death if the patient’s treatment is hindered by ineffective antibiotics as a result of poor drug selection or an antibiotic-resistant pathogen.

In future, we hope not to have to list the unavailability of an appropriate antibiotic as a cause of harm for a large number of pathogens.

Risk is also increased if the patient is not diagnosed and treated for sepsis within what is sometimes called “the golden hour”, the first hour following the development of associated organ dysfunction. This can make the difference between a survival rate of about 80 per cent and a survival rate of only 30 per cent, if left for six hours.

This shows just how important correct, prompt diagnosis and treatment of sepsis − with the right antibiotic, at the right dose, for the correct period of time − is to improving survival rates.

Barriers to new research

While further research and development into new antibiotics will help in the fight against antibiotic-resistant diseases, this has slowed in some developed countries as a result of regulatory challenges that discourage R&D. Since 1983, for example, the number of antibiotic drug approvals granted by the US Food and Drug Administration has declined eightfold.

‘We must all work together to protect modern medicine and combat antibiotic resistance’

Using antibiotics more prudently worldwide is the most viable solution in fighting the war against sepsis.

Everyone in primary care needs to work together to ration antibiotics effectively. Specific programmes in antimicrobiobal stewardship have shown improvements in individual patient outcomes, reducing the overall challenge of antibiotic resistance and offering real cost savings for healthcare. Programmes such as these are still in the minority and are not embraced across our health systems.

Life saving programmes

On the front line, nurses and doctors play a crucial role. Their input into length of treatment, prescription, route and timing of administration, and therapeutic drug monitoring all have a part to play in tightening the stewardship of antibiotics.

If healthcare practitioners are aware of, and recognise, the importance of working towards reducing antimicrobial resistance where possible, they have the power to become strong and important influencers in the hospital and care ecosystem.

Responsibility for programmes such as these is not limited to hospitals alone. Policy makers, governments, health service managers and administrators must all work together to protect modern medicine and employ effective prevention strategies to combat antibiotic resistance. By working together, lives will be saved.

Dr Ron Daniels is executive director of the Global Sepsis Alliance