The modern world owes its existence to the industrial revolution and medicine, and it’s hard to dispute the beneﬁts both have brought. But you can have too much of a good thing. Overuse of antibiotics is leading to the development of antibiotic resistance in many bacteria, meaning antibiotics are becoming useless for some infections. If the trend continues, there is a possibility that trivial ailments like chest infections will become untreatable and even basic surgery will become impossible. This ‘antibiotic apocalypse’ is creeping ever forward with each drug prescription.
The more we use antibiotics, the more likely it is these antibiotic-resistant bacteria can gain a foothold, outperforming other strains. Antibiotics are dished out daily in prescriptions from GPs, pharmacists and vets, as well as in battery farms to both prevent illness and promote growth. This cavalier attitude to the use of antibiotics has led to the emergence of so-called ‘superbugs’ like MRSA and Clostridium diﬃcile. Infections from these superbugs are sometimes completely untreatable and, without a change in the way antibiotics are administered, the number of multi-drug resistant strains of bacteria will continue to rise. According to Dr Craig MacLean of the University of Oxford Department of Zoology, “By 2050 it’s predicted that antibiotic resistant bacteria will be responsible for ten million deaths every year.” The ultimate end of this trend is the so-called ‘antibiotic apocalypse’, in which all known antibiotics are no longer eﬀective in treating disease, causing previously trivial infections to become life threatening.
It’s not just the healthcare system that will be challenged, the economy is set to take a hit too. “In a post-antibiotic world, you might go to the GP with a chest infection,” MacLean explains. “They might tell you that you’ll be ﬁne, but you need to take three or four months oﬀ work. That’s going to have a huge eﬀect on the economy.” This situation is only exacerbated by the fact that there has been a drought in antibiotic discovery since the 1980s.
We can postpone the arrival of the post-antibiotic world, but it’s going to require some signiﬁcant changes to how antibiotics are used. Many antibiotics are prescribed needlessly because it’s very easy to confuse a bacterial infection with an infection caused by a virus. Antibiotics are eﬀective against bacteria but cannot kill viruses. As a doctor, if a patient arrives at a hospital with ﬂu-like symptoms, they could either have the ﬂu, which is caused by a virus, or they could have a bacterial infection. Antibiotics will be useless against the ﬂu, but a bacterial infection could be harmful if left untreated. Do you assume it’s the ﬂu and send them home for some rest or do you give them antibiotics just in case? Diagnostic tools that help doctors distinguish between viral and bacterial infections do exist, but they’re currently too expensive for global use.
The inability to distinguish types of infection is only part of the problem; the attitude of patients can be an issue too. Most people aren’t aware of antibiotic resistance, and our busy lives mean we just want a pill to help us as quickly as possible. Many people feel more comfortable walking out of the doctor’s surgery with a prescription. “People are seeking medicine as well as advice,” said Professor Chrisoph Tang of the Sir William Dunn School of Pathology. Tang believes educating patients about antibiotics could help signiﬁcantly. “In Scandinavia, the general public are well educated about antibiotic resistance. Antibiotic use is lower there and we see less antibiotic resistance.”
If the four horsemen of the apocalypse are indeed just around the corner, it’s Pestilence leading the charge. Antibiotic resistance is an imminent threat and left unchecked it will change the face of modern medicine.
It’s not too late for the horsemen to falter, change is possible and in some cases simple. Antibiotics need to be used more sparingly, but we need aﬀordable technology to help this happen. Equally importantly, we need to be more aware about what we can do. We have to stop demanding antibiotics from our doctors and, if we are given some, we must ﬁnish the prescription.