Antibiotics: too much of a good thing?

We take them for granted and GPs seem to hand them out like sweets. But if we’re not careful, antibiotics may stop saving lives. By Rachel Eaton and Sarah Barnard

Think about a world where tuberculosis, pneumonia, meningitis and other infectious diseases are deadly. And where childbirth claims the life of one in every thousand women.

 

This is how it was before the discovery of antibiotics - and how it could be again if we continue to overuse these life-saving drugs. Unless we begin to treat them with a little more respect, the emergence of resistant superbugs will mean that antibiotics could lose their power to cure. And without them, surgery - including organ transplants - would no longer be routine. Even back in 2003, Professor Hugh McGavock of the University of Ulster warned that by 2015 disease-causing bacteria could well be resistant to all antibiotics.

 

March of the superbug

Attack any organism and it will mutate to increase its defences; it's called ‘natural selection' - the survival of the fittest. For example, widespread resistance in the malaria parasite has rendered the cheap and effective drug chloroquine almost redundant, while resistance in the human immunodeficiency virus (HIV) threatens the efficacy of antiretrovirals.

 

When penicillin was introduced in the mid-1940s, microbiologists were aware of this problem and addressed it by setting up the prescription system to restrict usage. But we're now seeing the demise of the antibiotic age with the rise of resistant bacteria such as MRSA (methicillin-resistant Staphylococcus aureus), a major cause of wound infections and pneumonia.

 

The emergence of antibiotic-resistant strains of TB is another worry. In the UK, around 5,000 patients a year die in hospital from bacterial infections. And the bacterium Acinetobacter baumannii, which affects intensive care patients, is untreatable.

 

Poor practice

Overprescribing by GPs and misuse by patients are major factors. As patients, we often pressurise our GPs into prescribing a cocktail of antibiotics, for everything from viruses to coughs and colds.

 

A government campaign this year has urged GPs to curb this overuse and make the public aware of their ineffectiveness against non-bacterial illnesses. The government is also trying to reduce prescriptions for common bacterial infections, such as those of the chest, ear and throat, which a healthy immune system should tackle within a week or so. But research published last year by the UCL Centre for Infectious Disease Epidemiology in London found that although prescribing for acute respiratory infections had fallen by 45 per cent in the past 10 years, in 2000 two-thirds of patients with respiratory complaints were still given antibiotics, along with 80 per cent of those with ear infections and 60 per cent who simply had sore throats.

 

"The more we take antibiotics unnecessarily, the more bacteria will become resistant to them," warns Sir Liam Donaldson, chief medical officer of the NHS. "We must all play a part in conserving antibiotics as a valuable clinical resource. Patients should take other remedies to help relieve a cold or cough - and a pharmacist is well placed to give this advice to you."

 

 

Immunity threat

Taking antibiotics regularly, or incorrectly, can prompt resistance in some of the bacteria in your body, making you resistant to the benefits of the drug in future. "It's quite common that when a patient suffers from a recurring infection (such as in the urinary tract) and is prescribed the same antibiotic several times over, they become resistant to its benefits," reveals Angela Chalmers, consultant pharmacist at Boots. "It could happen with an antibiotic that you've only taken three or four times. And it's more likely to occur if you stop taking the drugs before you finish the course - or if you don't take them as directed. Should you then contract MRSA in the future, there would be fewer antibiotics available to treat you effectively."

 

Hidden in our food

Another major factor in antibiotic resistance is the widespread use of the drugs in meat production. More than half of all antibiotics produced worldwide are used in animals; to treat infections in livestock, to prevent infections and, most contentiously, to increase growth rate. But many antibiotics used to treat animals are similar to those prescribed for humans, and mounting evidence suggests that antibiotic-resistant bacteria could be passed to humans.

 

Fears about the risk to health have led to the Soil Association lobbying the government to tighten legislation. "MRSA has not yet been found in farm animals in the UK, but that may only be because little testing has been done," says Richard Young, policy advisor for the Soil Association. "Meanwhile, in Holland, it is estimated that 40 per cent of pigs and 50 per cent of pig farmers already carry an active strain of farm-animal MRSA. 

 

"After much pressure, the British Government has finally begun testing British pigs for MRSA, but as three people in Scotland have already been infected with the farm-animal strain of MRSA, it has clearly found its way into the UK. All three made a full recovery, but treating this new strain is more difficult as the range of effective antibiotics is limited. The best advice is to be extra careful when you're handling raw meat. Also note that organic British meat is likely to be safer than imported meat."

 

Internal damage

Exposing yourself to unnecessary antibiotics can have other health implications. Antibiotics are unable to distinguish between the body's good and bad bacteria. "Antibiotics destroy the good bacteria in your gut, which can leave you exposed to further infections," says Angela Chalmers. "If you must take antibiotics, take a probiotic supplement (such as Boots Probiotic and Prebiotic, £7.99 for 30) on an empty stomach at least three hours apart from your antibiotic. This can also help protect you from contracting an antibacterial infection such as MRSA, by boosting your immune system - so it's worth taking if you're going into hospital."

 

Hopefully, now that the government and the public are becoming more aware of the problem of antibiotic resistance, use will be restricted and the growing rate of resistance will slow. Currently, antibiotics are still remarkably effective at curing diseases - but we need to treat them with greater respect if we're to continue relying on their efficacy.

 

When you do need antibiotics

Antibiotics are only effective against bacterial infections, not viruses, and most can be fought naturally by a healthy immune system, without resorting to medication.

• Chest infections and coughs - If you have asthma, heart problems or are elderly, you may not be able to fight these naturally. Also, see your GP if symptoms persist beyond a week; you have pain in your ribcage; or you cough up blood, foamy sputum or mucus.

• Sinus infections - If you notice a brown, discoloured nasal discharge, along with persistent headaches and a temperature, antibiotics may be necessary.

• Cystitis - Mild cystitis should clear up within four days. If it persists, see your GP for a short course of antibiotics, as complications can be serious.

• Genital tract and sexually transmitted infections - Most STIs require antibiotic treatment. It's important to see your GP as soon as possible, as even those with minor symptoms, such as chlamydia, can have serious consequences, including infertility.

• Impetigo - This contagious skin disease, common in children, is characterised by oozing and crusted sores. It is not normally serious but antibiotic creams are usually prescribed to minimise the risk of it spreading.

• Meningitis - Anyone showing signs of meningitis, including fever and chills accompanied by a rash, should be rushed to hospital. If the infection is bacterial, intravenous antibiotics will be administered.

 

When you don't

Antibiotics are ineffective against common viruses and are unnecessary for the following bacterial infections:

• Common colds and flu - If you're elderly or have a chronic condition, such as asthma or diabetes, ask your GP for a free flu jab.

• Ear infections - Unless you have a discharge, which indicates a perforated eardrum, you shouldn't need antibiotics.

• Childhood diseases - These include mumps, chickenpox and measles. But if symptoms are persistent or severe, see your GP.

• Sore throats and coughs

• Conjunctivitis - Only stubborn cases of this eye infection need antibiotics - most will heal without treatment within two weeks.

 

How to take them

• Always finish the full course of antibiotics, even if you begin to feel better.

• Take them at the directed time each day, and at regular intervals.

• Never share antibiotics or use an old, unfinished course for a future illness.

• Antibiotics can interfere with the contraceptive pill, so take extra precautions.

Please note: these guidelines do not apply to babies and younger children, who should be seen by a GP much sooner, especially if they have a temperature.

 

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