Antibiotic resistance: health in crisis

If we keep overusing antibiotics, common bacterial infections may put our lives at risk in the future.

Health Agenda magazine
January 2018

You’ve had a bad cold for 5 days and it’s just not shifting. Fed up with the sneezing, sore throat and all-night coughing, you go to your doctor hoping to fast track your recovery with a course of antibiotics.

It’s a scenario many of us are familiar with. Yet if you leave with a prescription and you don’t have a bacterial infection, it may be a lose-lose situation.

“Firstly, antibiotics work on bacteria, not on the viruses that cause colds and the flu,” says Professor John Turnidge, senior medical advisor for the Australian Commission on Safety and Quality in Health Care. “Secondly, this ongoing misuse of antibiotics is putting the future health of all of us at risk.”

According to the World Health Organization, antibiotic resistance is when “bacteria change in response to the use of these medicines” making the illnesses they cause harder to treat. Antibiotic resistance is rising to dangerously high levels and is one of the biggest threats to global health.

It leads to longer hospital stays, higher medical costs and increased numbers of deaths from bacterial infection. Antibiotic resistance is also threatening the ability of the medical profession to treat infectious diseases including pneumonia, blood poisoning and gonorrhoea.

Our go-to helper

The history of antibiotics has so far been a success story; they’ve saved millions of lives since they were introduced in the 1940s.

“These antibiotic medicines are used to treat a wide variety of infections or diseases caused by bacteria, such as respiratory tract infections including pneumonia and whooping cough, urinary tract infections, skin infections and infected wounds,” says Dr Andrew Boyden, medical advisor with NPS MedicineWise. And in some cases, antibiotics may also be needed to treat sinus, middle ear, tonsil and throat infections.

Unfortunately, according to a report by the Australian Commission on Safety and Quality in Health Care, antibiotics are frequently being over-prescribed for conditions that antibiotics aren’t recommended for, or at higher rates than recommended. In 2015, almost half of the Australian population (44.7%, or about 10.7 million people) had at least 1 antibiotics script filled.

These prescriptions aren’t necessarily needed: a recent study published in The Medical Journal of Australia found that for respiratory infections such as bronchitis and tonsillitis, Australians were prescribed antibiotics at 4–9 times more than the recommended rates.

These figures are cause for great concern, according to Dr Boyden. “Taking an antibiotic when it’s not needed will not make a significant difference to how you feel or how fast you recover. When you start to feel better it’s usually because your immune system is doing the work to treat your infection. This may happen around the time people go to their doctor seeking antibiotics.

“If they start the antibiotics course they think that it’s the drug helping them recover from their cold, when in reality, it’s just their immune system finally getting on top of the virus.”

The more antibiotics are used, the more chances bacteria have to become resistant to them, Dr Boyden warns. “People can then pass resistant bacteria on to others in a number of ways, including through coughing or contact with contaminated hands.”

Survival of the fittest

“Bacteria have been on the planet for 2 billion years, so they have learned plenty of survival tricks,” says Prof Turnidge. “These issues are no longer just a problem in hospitals and agriculture; they are also now occurring in people in the general community.”

When infections can no longer be treated by common antibiotics, more expensive medicines must be used and may not always work, says Prof Turnidge. “Treatment often requires admission to hospital. The person may remain sick for much longer or end up with chronic health issues or other related health complications. In the worst scenario, the bacterial infection could kill them.”

The rise of ‘superbugs’ is of particular concern. “Superbugs are bacteria that are resistant to several different antibiotics,” says Dr Boyden. Examples include the bacteria called Staphylococcus aureus, (also known as golden staph) commonly found in hospitals, and the bacteria that cause tuberculosis (Mycobacterium tuberculosis), which are now very hard to treat because of antibiotic resistance. “Many strains of Escherichia coli (E. coli), the bacteria that cause many urinary tract infections, are also becoming highly resistant to antibiotics,” he says.

What lies ahead

According to a 2014 World Health Organization report, a post-antibiotic age in which common infections and minor injuries can kill is a very real possibility in the 21st century. Procedures such as organ transplantations, caesarean sections and heart surgery, plus treatment like chemotherapy, also become much more dangerous without effective antibiotics for the prevention and treatment of infections.

“You only have to wind back the clock to when penicillin was not available [prior to 1941] to get an idea of what a world without effective antibiotics looks like,” says Prof Turnidge. The young and old were particularly at risk. “Common infections like staph, streptococcus in the throat and E. coli could kill,” he adds.

Reducing resistance

In the future, alternatives to antibiotics are going to be very important.

For now, the Australian Government has funded a National Antimicrobial Resistance Strategy to help reduce the threat of antibiotic misuse and resistance.

The strategy includes initiatives such as restrictions on the prescription and use of antibiotics, surveillance of antibiotics use, hand hygiene education, as well as initiatives to educate prescribers on the appropriate use of antibiotics.

Although we should only use antibiotics when necessary, you should always seek medical advice in relation to antibiotics and illness.