What would we do without antibiotics?

At one point antibiotics were a cure-all. Go to the doctor for any little ailment, antibiotics were prescribed and then you’re cured. Overprescription, patients not finishing their full course of antibiotics and some very clever evolution on the part of bacteria has led to antibiotic resistance becoming a wide-spread problem.

Discovery of penicillin
AntibioticsWhen Alexander Fleming discovered penicillin in 1928 it changed the world. Common diseases with no cure were suddenly treatable. Antibiotics have saved countless lives and I think we’ve nearly all taken them at some point. I know I have.

I had a sore throat as a child and although on my first visit the doctor said I would be fine in a few days, I soon developed a raging fever and a rash. The second time my mum took me to the doctor he told her “Oh, she has scarlet fever. People used to die of that you know”.

Not particularly comforting for my mother (I don’t think she’s forgiven the doctor; she still talks about it) but I was fine; scarlet fever is treatable with a course of penicillin. That and a whole host of other, previously life-threatening, diseases. However, in the wake of rising antibiotic resistance, these infections could become deadly again.

Post-antibiotic era
According to a recent report by the World Health Organization we are facing a global public health emergency and without action we will end up living in what they’ve called a post-antibiotic era.

In 2009, more than 3 million kilograms of antibiotics were given to patients in the USA alone so it’s not really surprising that antibiotic resistance is on the rise. Yet there is a ‘discovery void’ and no major new antibiotics have been developed in the last 30 years.

What does this mean for us? Without new antibiotics, common infections and minor injuries could become life-threatening and major surgeries and chemotherapy impossible because the treatments we have been using for years are no longer effective. In fact, there are already several cases of extensive drug-resistant infections, including untreatable gonorrhea.

Antibiotic resistance in the ICU
Generic pink bacteriaCritical care specialists are dealing with antibiotic resistance every day. They regularly treat patients that require extended hospital stays and combinations of different antimicrobial therapies, which risks the spread of antibiotic resistance genes.

Therefore, Critical Care is launching a new review series exploring the problem of ‘Antibiotic resistance in the ICU’. The series will focus on the mechanisms of resistance, spread of antibiotic resistance genes, efforts to limit the further spread of multidrug resistant pathogens, and novel current and future therapeutic approaches to respond to the challenge of antibiotic resistance.

In the first review of the series, Brad Spellberg discusses the future of antibiotics and explains that not only do we need new antibiotics to treat patients (even suggesting solutions to encourage new antibiotic development) but, more importantly, “we must learn how to not use and abuse” them so that they remain effective.

Carbapenems are a class of β-lactam antibiotics similar to penicillins but with a broader spectrum of activity. For this reason, they are often the last resort against serious infections. However, even these are no longer totally effective.

Infections caused by carbapenem-resistant Enterobacteriaceae have a high mortality rate and present a huge challenge to the medical community as they are often already resistant to the other major classes of antibiotics.

Michele Yamamoto and Aurora E Pop-Vicas review the limited treatment options for carbapenem-resistant Enterobacteriaceae like Klebsiella pneumonia, which can cause pneumonia, bloodstream infections, and meningitis. They are in agreement with Brad Spellberg that we desperately need new therapies to be developed and better antibiotic stewardship practices in place.

What’s next?
Antibiotic resistance is something we should all be aware of and be working to prevent.

UK Prime Minister David Cameron has today described antibiotic resistance as “a problem that is going to affect every country in the world” and that it could send us back to the “dark ages” where formally treatable diseases cause the deaths of thousands of people.

Because of this a new global group is being set up, with the support of US President Barack Obama and German Chancellor Angela Merkel, to deal with the problem of antibiotic resistance, the lack of new antibiotics and overprescription of these drugs.

Not only this, but it has also just been announced that antibiotics are the focus of the Longitude Prize 2014. This is a challenge “to create a cheap, accurate, rapid, and easy-to-use test for bacterial infections” with a £10 million prize fund. Hopefully this will provide more accurate diagnosis of infections so that the correct antibiotic is prescribed, an important step forward in the fight against antibiotic resistance.

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