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The Chief Medical Officer, Professor Dame Sally Davies, warned:

“Antibiotics are losing their effectiveness at a rate that is both alarming and irreversible – similar to global warming”.

Antibiotics being prescribed for relatively mild conditions are causing the drugs to be less effective for major conditions. Bacteria are adapting and finding ways to survive the effects of antibiotics, ultimately becoming resistant so they no longer work. There are few antibiotics being developed and that may lead to a crisis. Antibiotics work by targeting structures on the bacteria which are different from our cells –such as cell walls. Leading microbiologists say that there are only a small number of ways of attacking bacterial cells and these are being exhausted. If we squander the antibiotics we have we will not necessarily have new antibiotics to take their place.

The fight against infectious diseases has been truly remarkable. It is rare for people to die purely from an infection, deaths from cardiovascular disease and cancers are more common. However in the 19th Century infectious disease was the leading cause of death. The cholera outbreak in 1858 killed 52,000 people in just a few months including much of the population of London. The Spanish Flu, just after the 1st World War killed between 20-50 million people, far more than the War itself. Improvements in sanitation and infection control were important but anti-microbials [antibiotics and antivirals] have been enormously useful. We now have viral as well as anti-bacterial drugs. HIV, considered rapidly fatal just a few years ago, is associated with a normal life span if detected early and treatment is complied with properly. However the over use of anti-microbials, patients not completing courses or taking drugs irregularly so bacteria are not completely killed off and have a chance to adapt to the antibiotic is leading to resistance.

Clostridium Difficile and MRSA [ methicillin (not multi) resistant staphylococcal aureus] are hospital acquired infections caused by the use of broad spectrum [those that kill a wide variety of bacteria] antibiotics. C Difficile and MRSA infections are major complications after surgery and procedures such as transplants and cancer treatment. Broad spectrum antibiotics kill of the harmless bacteria normally lining the skin and gut respectively. This creates room for unusual bacteria that are resistant to the antibiotic to grow. This is why ‘healthy bacteria’ are promoted in probiotics to replace those normal bacteria lost after gastroenteritis and antibiotics.

Unfortunately probiotics seem to have little effect. There is a research trial going on to see whether eating capsules of normal faeces [containing normal bacteria] may help instead – it’s logical even if it may seem disgusting!

NEWS FLASH – An article in the BMJ   due be published on Saturday 24/11 reviewing trials of probiotics suggests that  probiotics are effective at preventing C. Difficile  infections. Phew – I  much rather have a probiotic yoghurt and I am sure patients would too! Patient compliance [patients taking their prescribed medicines] would I am sure be a problem with capsules of faeces!

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