Antimicrobial resistance - an end to medicine as we know it

Alexander Fleming was not a tidy man. His laboratory was constantly cluttered with various bacteriological experiments. One day in 1928, when he was tidying up some Petri dishes on which he had been culturing staphylococcus bacteria, he noticed that one of the dishes contained the growth of a curious mould. Subsequently found to be Penicillium notatum, this mould would not allow the staphylococcus to grow in its vicinity. The rest, as they say, is history.

Fleming initially published his findings in the British Journal of Experimental Pathology but excited little public interest. His enthusiasm waned as a result and it was not until the late 1930s that two eminent bacteriologists, Howard Florey and Ernst Chain, revisited Fleming’s ideas and built on his work. In 1941, spurred on by the infectious horrors of World War II, they successfully produced a clinical antibiotic. Fleming was knighted for his efforts in 1944. A year later, Fleming, Florey and Chain were jointly awarded the Nobel Prize in Medicine. 

How different the world might have been without this serendipitous discovery, and yet how easy it is to take for granted. In the past 80 years, we have seen a golden age in the treatment of infection. Surgical procedures, organ transplantation, cancer treatment – none would have succeeded without antibiotics. But this golden age is at risk of ending soon. The World Health Organization, publishers of Antimicrobial Resistance: Global Report on Surveillance (2014),¹ sees antimicrobial (including antibiotic) resistance as one of the most urgent threats to global health, food security and economic development. Of course antibiotic resistance occurs naturally, but the misuse of antibiotics in healthcare and agriculture is accelerating this process significantly. Antibiotics are becoming less effective at treating common diseases such as pneumonia, tuberculosis, gonorrhoea and salmonellosis. This ultimately means higher medical costs, prolonged stays in hospital and increased mortality. 

The Department of Health has published Ireland’s National Action Plan on Antimicrobial Resistance 2017-2020 (iNAP).² It opens with a chilling quote by Dr Margaret Chan, former WHO director general, who asserts that “a post-antibiotic era means, in effect, an end to modern medicine as we know it”. Estimates already suggest that if this global problem is not dealt with, antimicrobial resistance will account for some 10 million deaths annually by the year 2050. That is more people than are currently lost to cancer and represents a cost of US$100 trillion in unrealised global production.

The WHO observes that, although new drugs are constantly in development, none are currently likely to be effective against the most dangerous forms of antibiotic-resistant bacteria. Occasional promising innovations grab headlines, such as recent media reports on research at the University of Belfast into the use of microneedle patches to deliver antibiotics directly to the bloodstream thus bypassing the gut and reducing the risk of resistance. But we still need urgent change in the way antibiotics are prescribed and used. Moreover, it behoves us to prevent the spread of infection in the first place by promoting vaccination, hand washing, food hygiene, safe sex and so forth. 

The aims of iNAP are five-fold: to improve awareness of antimicrobial resistance; to enhance surveillance of antibiotic resistance and use; to reduce infection and disease spread; to optimise the use of antibiotics in human and animal health; and to promote research and sustainable investment in new medicines, diagnostic tools, vaccines and other interventions. Ambitious as this might seem, it is imperative that such plans are successful worldwide.

References

1. World Health Organization (2014). Antimicrobial Resistance: Global Report on Surveillance
2. Department of Health (2017). Ireland’s National Action Plan on Antimicrobial Resistance 2017-2020 (iNAP)