It’s a nightmare scenario: You’re struck down with an illness, the doctors prescribe you antibiotics, and… nothing happens.
But this is already a reality for some.
We’re in the throes of an antibiotic crisis and there is a real risk that the drugs won’t work and it could end up killing millions each year.
Years of overprescribing have made some bacteria in our bodies immune to the drugs, meaning we struggle to shake off some illnesses and diseases that previously antibiotics would have made light work of.
‘There is a strain of salmonella they’ve found in the United States that is completely drug-resistant,’ says Peter Gibson, of the charity Antibiotic Research UK.
‘Antibiotics wouldn’t work with it at all and increasingly we’re hearing more about conditions like UTIs and strains of pneumonia that are resistant in some people.
‘We’ve overused and misused antibiotics and that’s really the problem. Bacteria in our bodies have changed and become resistant to the drug.’
Between 2000 and 2015, antibiotic use increased by 65%, driven by a boom in prescribing in developing countries.
In 2015, an estimated 42 billion doses were swallowed, according to research by Dr Eili Klein of Johns Hopkins University’s Centre For Disease Dynamics, Economics And Policy and his colleagues.
‘In most countries, including the UK, the rates of antibiotic usage have gone down or haven’t increased much over the last several decades,’ Dr Klein tells Metro.co.uk.
‘But in many of the low and middle-income countries, antibiotic usage has gone up, largely due to economic development.’
Assuming there are no policy changes, consumption is projected to increase by 200% to 128 billion daily doses by 2030.
And all of the increase, Klein says, can be easily understood:
‘Countries can now afford antibiotics for their medical system,’ Dr Klein says.
Many of the drugs, which were developed in the 1960s and 1980s, have also seen their patents expire, meaning generic, cheaper versions of the drugs can be used – improving their usage.
This means that they are cheap for patients to purchase.
What worries researchers is a lack of successful research into new drugs:
‘We’re still using pretty much the same antibiotics we did in the 60s and 70s,’ Gibson says.
‘There hasn’t been any investment in the development of new antibiotics.’
Until recently, no new approved class of antibiotics has been discovered since 1980, while nothing to tackle what’s called ‘gram-negative’ bacteria – prevalent in many of the superbugs causing illness and more difficult to treat with antibiotics – has been discovered since 1962.
‘It’s simply not profitable enough for drugs companies,’ says Gibson, who is calling for the government to incentivise the development of new antibiotics.
‘There’s no use developing a new cancer drug or heart drug if someone then dies of hospital-acquired infection.
‘It’s got to be primary in their thinking now and it’s essential that we develop new antibiotics.’
Doing so costs money, though – and lots of it.
‘It can cost $500 million (£415m) per drug,’ Laura Piddock, director of scientific affairs at the Global Antibiotic Research And Development Partnership, tells Metro.co.uk.
‘It’s still surprising that, as antibiotics save lives and individuals usually live for many, many years after treatment, so little funding is available.’
The danger here is that, once antibiotics lose their potency in one person, it can quickly spread.
‘People don’t become resistant to antibiotics, bacteria do,’ Piddock says.
Emily Collins was diagnosed with bacteria-resistant E.coli when she was 21.
She had been suffering from urinary tract infections for years, which were treated with a narrowing range of antibiotics.
‘When one stopped working, they gave me another,’ she told Antibiotics Research UK.
‘It wasn’t a problem… there seemed to be a never-ending list of treatments.’
Until they stopped working and the list of potential treatments was getting shorter.
It ended up with her losing her job, no chance of a career in nursing and left a condition without a cure.
‘This is a ticking time bomb,’ Collins says.
‘Antibiotic resistance is going to become a massive problem in the very near future unless challenged.’
Developing bacterial resistance isn’t common but, researchers believe, the larger concern is spread, rather than scale.
‘When you think of the amount of antibiotics produced, it doesn’t have to be that common,’ says Dr Klein.
‘Once a resistant bacteria appears, it can spread from person to person and spreads much easier in the context of a lot of antibiotic use.’
This problem is exacerbated by GPs overprescribing antibiotics, with around a fifth of prescriptions being incorrectly or unnecessarily given to patients.
‘When you go to the GP because you’ve got a cough and they give you an antibiotic, those sorts of things are often inappropriate and may only provide a tiny bit of benefit – your duration of illness is one day shorter – but the longer-term societal effects are great,’ Klein says.
Antibiotics are generally safe and cheap and this has led to their increased prescription.
‘In many cases, it’s cheaper to give an antibiotic than to run a diagnostic test and figure out what’s actually wrong with someone,’ Klein says.
Many bacteria spread in hospitals – and hospitals tend to prescribe plenty of antibiotics.
‘It’s important to note that antibiotics are given to all patients who have surgery, usually beforehand, and if they acquire a post-operative infection then afterwards as well,’ Piddock says.
‘This is why drug-resistance threatens our ability to carry out organ transplants and joint replacements.’
That’s a real concern: that bacterial immunity to antibiotics could render many commonplace medical treatments impossible to do safely.
‘This is why there’s a sense of urgency now,’ says Gibson.
‘We don’t have the alternatives to antibiotics developed yet and the real worry is that if they stop working completely we go back to an age where it is possible you could die from an infected scratch.’
While the experts admit resistance has been known about since the heyday of antibiotic development, they never assumed the day that we’d become resistant would arrive quite so quickly.
But it seems like increased awareness – and alarming headlines – are making companies act.
‘This is a market system, and companies have to respond to problems,’ Dr Klein says.
‘The problem is that rather than being ahead, we have a large number of people who will suffer because we won’t have drugs for several years.’
So without new drugs to tackle infections, what will happen?
The experts aren’t forecasting cataclysmic doom but it’s not exactly optimistic:
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‘You could have quite routine surgical procedures that have to be postponed,’ Gibson says.
‘They’d be more worried about you getting an infection that could prove more deadly than you having a new hip.
‘You might be in a situation where you can’t do things like hip replacements and knee replacements – routine surgery – because of the fear of infection and not being able to treat it.’
And until we see new antibiotics rolled out, doctors say patients need to take personal responsibility:
‘Stop demanding antibiotics from your doctor,’ Gibson says.
Gibson has heard anecdotal evidence of GPs being threatened with violence for declining to disseminate antibiotics to patients.
‘Patients believe they’re a silver bullet that can cure colds and the flu and everything,’ he says.
‘They’re not. They can’t. The more antibiotics we take, the greater the danger that bacteria in our body will become resistant to them.’
It may seem like a simple equation to solve: we take too many antibiotics so the solution is to reduce the number of antibiotics used.
‘If patients have to make a phone call, write out additional information or justify that prescription – that will probably have some impact,’ Dr Klein says.
But figuring out how to restrict the use of antibiotics is complicated and, if not handled correctly, could mean people who need them don’t get them.
In the short-term, experts are working on preventing infections in the first place.
‘This can be done by vaccination and good infection prevention control in areas of high microbial burden [places where bacteria thrive],’ Laura Piddock says.
‘Many of the bacteria that can cause the most serious infections are found inside the gut.
‘Access to clean water and good public health systems such as close sewers are essential to breaking the oral-faecal route of transmission.’
Even then, there is still the big issue of the development of new drugs.
‘One way to resolve this is for the public to put pressure on politicians to fund new treatments for infections in the same way as they lobby for new cancer drugs,’ Piddock says.
‘Funding to translate new treatments beyond phase one clinical trials [first human trials] remains challenging.’
Antibiotics are not as lucrative a drug to develop as things like Viagra, the experts say, because they’re taken as-needed for a short time.
Their problem, financially speaking, is how good they are. The reward, therefore, doesn’t match the financial risk.
One thing’s for certain: it’s not something that can be achieved alone.
If we don’t act, the reality is more bacteria will become resistant to antibiotics. And more people will die.
A UK government review believes that by 2050, 10 million people every year could die from antibiotic-resistant infections.
If there comes a time when the drugs really don’t work, the diseases we’re struggling to shake off now could end up becoming fatal.
‘We have to view this as a global health crisis and react accordingly,’ Gibson says.
‘If we’re going to tackle this, it’s a whole society thing.’
The Future Of Everything
This piece is part of Metro.co.uk’s series The Future Of Everything.
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