“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”. These words were spoken not by a politician or a philosopher but by the man that discovered penicillin, Alexander Fleming. From the very start of the Antibiotic Era we knew the potential dangers of abusing the drugs that could prevent deaths from minor maladies.
Today we have ignored these warnings and are starting to pay the price. The Review of Antimicrobial Resistance estimates that by 2050 the death toll per year from antibiotic resistant diseases will be 10m. This has both social and economic consequences. The cost to the EU of resistant bacteria is $1.5 billion a year, and this will only increase as more strains of pathogen develop resistance incurring massive costs to governments and people alike.
There are two main reasons for the ever marching army of bacterial evolution. The overexposure of agriculture and the problem of the commons.
In the US 70% of antibiotic sales are for use in livestock. This is dangerous as bacteria can become resistant to antibiotics in animals just as easily as in humans, and the effects are largely similar. Companies claim that pharmaceuticals aid growth and prevent excessive loss of life, compared with their organic cousins, leading to larger profits and increased production. However recent studies have shown this to be pig’s swill. When Denmark imposed bans on Antibacterial Growth Promoters in steps from 1995-2000 production actually increased and there was a clear reduction in the number of resistant bacteria found.
Overuse of antibiotics in food production can be tackled with relative ease. In the Netherlands the government set a target of a 50% reduction in antibiotic use in animals. The Dutch achieved a 56% reduction using defined daily dosages and more transparent prescriptions. This approach coupled with an ‘Antibiotics Free’ label, similar to ones used in the United States, being introduced in the UK would see consumers opting for the organic option, as a recent study showing that 81% of customers disapproved of sub-therapeutic drugs in animal feed. The synthesis of these policies would decrease the number of farmers abusing antibiotics as well as allowing the free market to favour organic products.
The second problem causing a tide of antibiotic resistance is the problem of the commons. On every prescription in the UK are guidelines on how to take antibiotics. Yet many of us fail to complete our course. This turns our body into a breeding ground for resistant bacteria that would have otherwise been killed. Individuals may feel that they are the best judge of their own treatment but often this is not the case.
To prevent excessive misuse and abuse of antibiotics we must put in place a range of solutions. Firstly many prescriptions are given for complaints that cannot be cured by drugs, a colossal 45% in the US. This is often due to patient pressure. Using placebos will allow doctors to reduce unnecessary prescriptions while satisfying the customer’s needs. Placebos have repeatedly and consistently been shown to provide an increase in the condition of patients, sometimes in parallel with drugs themselves when antibiotics would be of no medical value, while allowing no room for resistant bacterial evolution. A medical review, with the power to hand out sanctions, should be established to scrutinise GPs handing out excessive prescriptions that exceed guidelines. Furthermore the introduction of a patient prescription contract, containing instructions on how to take the antibiotics, alongside education campaigns detailing the dangers of misuse would place the consequences in the public conscience.
Finally major problems arise in payments between pharmaceutical companies and doctors. To combat this grants and prizes should be introduced to incentivise innovation to create new antibiotics, an area that has recently stalled. The production and profiting from the manufacture of drugs creates the need for companies to sell as many as possible, regardless of the consequences. Therefore governments should purchase the rights to manufacture antibiotics developed by the private sector, thus boosting innovation and making the development of new antibiotics profitable, and then synthesise the antibiotics themselves ending the payments to doctors that fuels over-prescription. The ever increasing need for non-antibiotic solutions will see the price of probiotics and bacteriophages increase opening up new research and production opportunities for the private sector to move into. Private companies would research and innovate on new antibiotics while continuing to produce other drugs and solutions.
In conclusion, the major causes of increasing antibiotic resistance, which could decimate both livestock and human populations, are overuse in animals and low levels of individual responsibility. Through a mixture of carrots and sticks we can reduce the amount of drugs sold. Implementing sanctions while enabling the free market to select for non-antibacterial options and promoting research using grants to find new antibiotics or other solutions would create tangible change. Furthermore introducing measures to combat rampant GP prescriptions, such as publishing prescription numbers and removing private sector payments, would be a huge step towards reducing the rate of antibiotic resistances developing. Antibiotic resistance is not a short term problem, it has the potential to severely damage economies and destroy lives. Simple measures could prevent the arrival of the post-antibiotic era until we are ready to face it and could save countless lives.