What is antibiotic resistance?
Antibiotic resistance, as summarised by the World Health Organisation, occurs when bacteria change and become non-responsive to first-line antibiotic solutions.
Why should I care about antibiotic resistance?
Antibiotic resistance makes bacteria harder to treat, leading to higher medical costs, longer hospital stays and, in some cases, increased mortality.
The threat of antibiotic resistance is such that UK Chief Medical Officer, Professor Sally Davies, proposed in 2011 that antibiotic resistance should be included on the national risk register, formally acknowledging it as a threat to British national security.
Causes of antibiotic resistance
Ventola (2015) lays out five potential causes of antibiotic resistance:
- Overuse. A concern raised as early as 1945 by Sir Alexander Fleming, who discovered the first antibiotic substance, benzylpenicillin, in 1923. Countless studies have shown a relationship between antibiotic consumption and the emergence of resistant bacteria strains. It is clear, therefore, that the overuse of antibiotics drives the evolution of resistance against those same antibiotics – and, as Ventola notes:
"despite warnings regarding overuse, antibiotics are overprescribed worldwide"
- Mistaken prescribing. A 2013 report from the Centers for Disease Control and Prevention (CDC) stated that “as much as 50% of the time, antibiotics are prescribed when they are not needed, or they are misused (for example, a patient is given the wrong [dosage])”. This is in America alone, but other studies reveal “unnecessary, inappropriate or suboptimal” prescribing of antibiotics in 30-60% of cases. As well as contributing to the development of antibiotic resistance, the therapeutic value of incorrectly prescribed antibiotics is questionable, exposing patients to potential side effects they need not experience.
- Agricultural use. Data on the use of antibiotics in the treatment of livestock is “not systematically collected” according, once again, to the CDC. In spite of this, the editor of international science journal “Nature” noted in 2013, that “antibiotics remain in wide use as growth supplements in livestock”. The use of antibiotics in food-producing animals kills, or at the very least suppresses susceptible bacteria, leaving resistant bacteria behind – which can then be transmitted to meat-eating humans.
- Lack of development. The number of applications for new antibacterial drugs decreased from 19 to 3 between 1980-1984 and 2005-2009, according to Ventola (2015), adding that “antibiotic development is no longer considered to be an economically wise investment”. The reasons for this are not immediately clear, though Antibiotic Research UK argue that investment is limited because antibiotic usage is inherently short-term and curative, making courses of antibiotics less profitable for pharmaceutical companies.
- Regulatory bureaucracy. An ongoing concern for pharmaceutical companies and medical professionals alike. Medicinal regulation, though undoubtedly important in protecting patients and ensuring safety in the treatments we prescribe, is a source of frustration for all of the reasons you might suspect – limited transparency, varied requirements between countries, new legislation and licensing rules replacing previous ones and so on.
The type of organisation that we are, we can only influence issues with overuse and mistaken prescribing. Our GPs will always have your best interests in mind, recommending the treatment that we think is the most suitable at every turn. On some occasions, that might well mean prescribing antibiotics, but as a general rule, we reserve antibiotic treatment for more serious conditions – doing as much as we can to avoid the development of antibiotic resistance.
Examples of antibiotic-resistant bacteria
Public Health England publishes data on resistance rates in key infections – namely Escherichia coli, Gonorrhoea, Klebsiella pneumoniae, Klebsiella oxytoca and Pseudomonas spp.
- Escherichia coli, better known as E. coli is a common form of bacteria, typically found in the intestines. The majority of types of E. coli are harmless, existing naturally in the normal flora of the gut, though some strains can cause serious food poisoning and infection. According to Public Health England, there has been an average 1.68% increase in strains of E. coli resistant to six separate antibiotics.
- Gonorrhoea, the third most commonly diagnosed sexually transmitted infection in the UK is commonly treated with antibiotics, and as such, the Neisseria gonorrhoeae bacterium that causes it, has become especially resistant to antibiotic treatment. As of writing, one strain of gonorrhoea has developed resistance to all classes of antibiotics used to treat it – hence the coining of the phrases ‘super gonorrhoea’ in the press.
- Klebsiella pneumoniae infections are most commonly seen in those with weakened immune systems, and the most common conditions caused by klebsiella are pneumonia and bronchitis. Klebsiella bacteria, like E. coli is resistant to at least six major antibiotics, with the prevalence of cases also increasing by 1.68% in figures from Public Health England.
- Klebsiella oxytoca is a bacterium that is particularly prevalent in neonatal intensive care units and adult critical care centres, according to Singh, Cariappa and Kaur (2016). The same study found K. oxytoca to be showing higher drug resistance than its contemporary, K. pneumoniae. In spite of this, cases of K. oxytoca antibiotic resistance only increased by an average of 0.26% between 2013 and 2017.
- Pseudomonas spp is usually naturally resistant to penicillin, and has become resistant to many more antibiotics on top of that. The Public Health Agency of Canada note that “multi-drug resistant strains are emerging”, however, and Public Health England data shows a 0.2% average increase in cases between 2013 and 2017.
No matter how we look at it, there are more cases of antibiotic resistance now than there were even five years ago – and this is even when we consider five or six separate antibiotics for a given bacterium. Antibiotic resistance has been reported throughout the scientific world, to the point of being raised in the House of Commons by the Health and Social Care Committee.
Antibiotic resistance is an ongoing concern, something we cannot afford to ignore or lose sight of, and as mentioned earlier in this piece, our doctors generally reserve the prescribing of antibiotics for more serious conditions – though this is by no means a one-size-fits-all policy, and you may end up with antibiotics for a more run of the mill condition. Our doctors will always have your best interests at heart, and can answer any of your questions about antibiotic resistance, and Push Doctor’s policies around the subject.