The problem of increasing bacterial resistance to antimicrobial drugs is a subject I am liable to bang on about for hours, given the slightest opportunity. The reason is that I believe it to be one of the most serious public health threats that we currently face, on a par with the rising levels of obesity that receive so much more publicity. Imagine a world where the slightest infection becomes untreatable because the bacteria responsible have developed resistance to all clinical antibiotics. Simple routine operations would become high-risk undertakings and a whole range of diseases caused by bacteria – from scarlet fever to bubonic plague – will once again become seriously life threatening. Few of us are old enough to remember a world without antibiotics, but if current trends continue, that world could easily make a comeback.
The World Health Organisation has added its considerable weight to the body of opinion that sees antibiotic resistance as a major problem with the publication of a report titled Antimicrobial resistance: global report of surveillance, which concludes that it is a “serious, worldwide threat to public health.” The report reveals that people in every country are already at risk from potentially untreatable infections and calls for urgent action to tackle the problem by more judicious use of antimicrobial drugs and an end to unnecessary prescribing. The report is aimed mainly at the clinical world, but also mentions the use of antibiotics in agriculture, which to my mind is equally to blame for the resistance problem. Using these precious drugs routinely to make animals grow bigger and faster and prevent diseases from spreading in overcrowded intensive farming environments is a crazy misuse of one of the most important medical advances ever made and has also created an emerging food safety problem. We are already seeing food poisoning outbreaks caused by bacteria that are resistant to several antibiotics. The recent multi-resistant Salmonella Heidelberg outbreak in the USA linked to chicken is a case in point. It’s no coincidence that 40% of those affected ended up in hospital.
I’ve been writing about this issue for at least 15 years, and in that time things have begun to change, though only slowly. Some Scandinavian countries have attempted to take antibiotics out of livestock farming altogether – with some success and without causing the predicted economic catastrophe for the industry – while legislation has been revised to stop some clinically important drugs from being used in animals. But much more needs to be done to avoid a return to the days when a bacterial infection could often be fatal. It’s worth remembering that no completely new class of antibiotic has been discovered for decades. The few new drugs being developed are mostly just new versions of existing ones, and unlikely to remain useful for long. We can’t assume that the pharmaceutical industry will invent a solution – too expensive and not profitable enough – so the only answer is to protect what we already have.