The Drugs Don’t Work - What Happens When Antibiotics Fail?
Antibiotic drugs are designed to kill or block the growth of bacteria - the germs that cause infection. Although the human body holds several billions of harmless bacteria, other bacteria can be pathogenic, leading to infections in the skin, throat, wounds or the urinary tract and bloodstream. The immune system is often unable to fight bacterial infection without help from antibiotic drugs.
The discovery of antibiotics represented a significant medical advance; they have been used ever since to cure serious and life-threatening illnesses, and have been employed extensively in post-surgical care, including following cancer treatments that suppress the immune system and put patients at risk of infection.
There is concern, however, that the capability of antibiotic drugs has been diminished by antimicrobial resistance (AMR). AMR is a natural process that occurs when microorganisms change their DNA during replication or when resistant genes are exchanged between them. In December 2015 fears emerged that the effectiveness of Colistin - the antibiotic of last resort, which is used to treat the most intractable and serious infections - has been fatally undermined by this process.
AMR is not a new phenomenon. Problems with resistance were found almost immediately in Penicillin, the initial group of antibiotics used to treat infections in the 1940s, and Penicillin ceased to be effective by the mid-1960s. Its success prompted the development of new antibiotic drugs, but the new antibiotics have often been effective only for a short time because they are just chemical variants of older agents.
This development means that these essential medicines are at risk of becoming obsolete. In fact, antibiotics have become ineffective at an alarming rate,1 which raises the prospect of a post-antibiotic era in which simple infections can kill people. Already very high rates of resistance have been observed in bacteria that cause common healthcare-associated and community-acquired infections.2
Resistance has developed in part because antibiotics have been prescribed when they are not needed. It’s a common fallacy that taking antibiotics helps treat infections caused by viruses (such as influenza), and some people take drugs intended for others in the mistaken belief they will help. Inappropriate use encourages even more harmful bacteria to evolve and flourish. In addition, when people fail to complete a full course of treatment, under-treated bacteria are not killed but actually allowed to change and become resistant.
The concern is that all this will take healthcare back to the 1900s - a pre-antibiotic era when no medicines were effective against common infections. In fact it’s a wider problem since treatments against some other microorganisms that can negatively affect our health - fungi, viruses and parasites - are also losing effectiveness.
Ironically, development of new drugs has also slowed despite the distressing knowledge that antibiotics have become less effective with their increased use. As a result, the medical community has recognized that more funding to find new antimicrobial drugs and alternative therapies is needed worldwide. The WHO established the Global Action Plan on Antimicrobial Resistance in May 2015. Recognizing that economic factors discourage investment in replacement drugs, one of the main objectives of the WHO plan is sustainable investment in new medicines.
In the meantime the UK, amongst other countries, signed onto the WHO European Strategic Action Plan on Antibiotic Resistance that was proposed in 2011, with the ultimate goal of stimulating the development of novel treatments. Most recently, in January 2016 the pharmaceutical industry committed its support to innovation and drug discovery through research jointly funded by governments despite citing formidable scientific challenges involved.
The race is on. Increasing numbers of patients in intensive care, haematology and transplant units have pan-resistant infections, meaning there is no effective treatment available. Antimicrobial-resistant infections already claim at least 50,000 lives across Europe and the U.S each year, and a (low) estimate of 700,000 worldwide.3 The global figure is projected to reach 10 million by 2050.
Underwriters have not been unduly troubled to evaluate the risks associated with simple infections, the after effects of routine surgery or childbirth before now, but AMR may have profound health consequences in the future. Meanwhile, people would be advised to use antibiotics with respect and only when required.
- Antimicrobial Resistance Global Report on Surveillance, World Health Organization (June 2014).
- Ibid at Note 1.
- Antimicrobial Resistance: Tackling a Crisis for the Wealth of Nations, Review on Antimicrobial Resistance (December 2014).