Health Risk Imposed by Antimicrobial Resistance

"The thoughtless person playing with penicillin treatment is morally responsible for the death of the man who succumbs to infection with the penicillin-resistant organism.” Said Sir Alexander Fleming in 1945 shortly after being awarded the Nobel Prize for discovering penicillin. Fleming despite the benefits of Penicillin was able to predict the outcome of its misuse, which we today know as antimicrobial resistance.

For those of you unfamiliar with the term ‘antimicrobial resistance,’ it is when microbes, such as bacteria, or viruses develop the ability to resist the medication that would previously treat the microbe. For the past couple of years, it has been seen as nothing more than a minor threat, which has resulted in a rapid emergence of resistant bacteria, diminishing the efficiency of today’s antibiotics. Antimicrobial resistance has now become one of the most urgent threats to public health, so why do so many of us still not know what it is?

In the diagram above, it is clear how rapidly Antimicrobial resistance came into play shortly after the introduction of the antibiotics. Take Methicillin for example, which was introduced in 1960, yet just 2 years later in 1962, the microbes began to grow resistant to the effects of the antibiotics.

The Antimicrobial Resistance Strategy was launched in 2013 and consisted of several government programmes put in place in order to halt the rise of AMR and further professional knowledge and training on the matter. However, the 2016/17 report published by the Advisory Committee showed that resistance continued to increase. The rise of resistant bacteria is the cause of many contributing factors, such as the over-prescription of antibiotics for unnecessary reasons. In the outpatient setting, a minimum of 30% of the course antibiotics prescribed is not needed. So think twice the next time your GP prescribes you Penicillin. A local GP from London, Dr. Amanda Brier, 35, believes, “If there is such an urgency to reduce the prescription of antibiotics, a substitute needs to be introduced. Otherwise, there’s gonna be a bunch of unhappy patients.” Due to the high effectiveness of antibiotics, many patients have become highly dependant on their use, creating a constant demand within the market.

General Practitioners have been attacked from all sides as a cause of antimicrobial resistance. Despite a 13% decrease in the prescription of antibiotics since 2013, the UK’s prescription levels remain approximately double that of Netherlands and Sweden. GP’s face a constant pressure from patients, who require a quick and simple solution to their health problems. As well as, the constant battle against the rise of resistant bacteria, in order to prevent a pre-medical era where an adult could die from a mere infected paper cut. Dr Brier went on to say that, “antimicrobial resistance is the fault of us all…it all comes down to our laziness and reluctance to change.” The over-prescription of antibiotics will always play a key role in the rise of AMR, as 97% of patients who go to the GP demanding antibiotics, have their demands met. When it comes to our health we as a society, are somewhat lazy and always on the look out for a quick fix to our problems. However, there are various contributors.

No new class of antibiotics has reached the market in decades, allowing the harmful bacteria to simply become immune to the effects of current antibiotics. The House of Commons Health Committee released a report on the 21st of October stating that by 2050, 10 million people will die per year if an effective solution is not discovered urgently.

“It scares me. I suffer from Tuberculosis, which is obviously a bacterial infection, I don’t know if or when my body could become resistant to the effects of the antibiotics I am on,” says Gemma Finch, 48, who was diagnosed with Tuberculosis in January of 2018. She remains under a constant danger imposed by antimicrobial resistance. Tuberculosis used to be an infection which could be treated with an easy 6 month course of prescribed antibiotics, however, due to our inability to explore new ways of treating bacteria, a new form of multi-resistant Tuberculosis has developed.

Mainstream pharmaceutical companies, such as GlaxoSmithKline, fail to make a profit from new antibiotics as antibiotics are prescribed on a short course basis, the sales numbers are limited, hence the deficiency in development. The government refrains from increasing the cost of antibiotics, which results in a minuscule financial incentive for pharmaceutical companies to conduct new research. There is simply no market in the evolution of new antibiotics, and we all know that business is business and everybody wants to get paid. A new way of compensating these large pharmaceutical bodies must follow. The government’s role within this has been highly criticised, as there is a clear and distinguished need for better funding and research facilities in order to conduct the work necessary. Promises were made in late July that £10 million in funding would be provided to help aid research, but yet effects have not been seen.

In July earlier this year, Novartis, one of the top 5 pharmaceutical companies, announced that it would no longer conduct research into antibiotics. In their published statement, the company spokesperson said, “While the science for these programmes is compelling, we have decided to prioritise our resources in other areas where we believe we are better positioned to develop innovative medicines that will have a positive impact for patients.” Has faith been lost in the restoration of antibiotics? This decision not only results in the loss of 140 jobs, it puts the remaining four companies under high levels of pressure to stop the ticking time bomb, which is antimicrobial resistance.

Now the level of consumption of antibiotics by animals and livestock isn’t something many of us think about. Not many of us have the time to worry about what our food ate, before it ended up on our plate. But it really is true when people say you are what you eat. A whopping 27 different classes of antibiotics are used within the animal market, and there is not actually any standardised data available on the global use of antimicrobials in livestock. Often livestock is fed antibiotics for reasons deemed unnecessary in order to promote their growth. Not only does this place the animals at risk of developing resistant bacteria, resulting in disease and infection, but the meat of the animal also becomes contaminated and is consumed by us, humans. A report into the effects of agriculture on the rise of AMR stated that, “Farmers need to dramatically cut the number of antibiotics used in agriculture, because of the threat to human health.” Not only does the level of antibiotics need to be reduced in livestock, but the way in which they are used must also be improved too. Farmers should only use antibiotics that have been registered by a veterinarian. Dr. Kazuaki Miyagishima, Director of the Department of Food Safety and Zoonoses at the World Health Organisation stated that, "The volume of antibiotics used in animals is continuing to increase worldwide, driven by a growing demand for foods of animal origin, often produced through intensive animal husbandry.” The constant use of antibiotics to help develop ‘better’ meat, is, in fact, creating a health risk.

All these various factors that have weighed in over the years to support AMR, have become the catalyst for something much worse, arise within the superbug crisis. Last year, a woman died as a result of being infected by a bug which was resistant to 26 different types of antibiotics, aka every single antibiotic that is currently available in the USA. Superbugs simply do not respond to the antibiotics that are available to us right now.

Regardless of all the attempts made to decrease prescription levels or reduce the general consumption of antibiotics, resistant bacteria has continued to flourish. There is a grave obligation for both the government and pharmaceutical companies to advance their research into antibiotics, and a need for us as a society to be better educated on the causes and effects of antimicrobial resistance, and why it should be a top policy.

This is the result of ignoring a problem until it is too late.