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Since the introduction of antibiotics almost one hundred years ago serious infections that once killed thousands of people have been all but eliminated. Well, maybe. The misappropriation and overuse of antibiotics worldwide has accelerated a rise in antibiotic resistant strains of bacteria that could threaten our sterile safety.
Bacterial infections have, once again, become a threat, and studies have shown a direct relationship between the consumption of antibiotics and the emergence of resistant strains of bacteria.
Last autumn the former UK health-turned-environmental secretary, Thérèse Coffey, incited alarm amongst doctors with the suggestion that the government’s ‘Our Plan for Patients’ policy would enable pharmacists to prescribe certain medicines, including antibiotics, without the approval of a doctor, in an effort to reduce GP appointments and waiting lists. A move that could further increase our misuse of these vital drugs without stringent training
The World Health Organization (WHO) has previously summed up how purchasing antibiotics without a prescription can worsen antibiotic resistance So, to prevent the advancement of antibiotic resistant super-organisms, which would otherwise launch us into a post-apocalyptic future where we could perish from a papercut, it’s important that we do our due diligence in following the guidelines set out by the experts.
Your body needs bacteria to thrive: they’re responsible for regulating digestion, protecting you against disease, and keeping your reproductive system in check. But some bacteria can cause infectious disease if they grow and replicate within our bodies. If you find yourself asking “what do antibiotics do?”, then to put it simply, the answer is: Antibiotics are a group of medicines used to treat or prevent pathogenic bacterial infections.
Superbugs are strains of bacteria that are resistant to the very antibiotics developed to treat the infections they cause. They evolve when people start taking antibiotics incorrectly, such as by taking them when they aren’t needed with the misconceptions that antibiotics treat every health misfortune, when shared with friends or family, and when inappropriately prescribed, such as in attempting to treat a virus, against which they have no effect.
When bacteria are overexposed to antibiotics, they respond by developing mutations in an attempt to survive. And because they can reproduce rapidly, with millions appearing within a few hours, they are able to modify themselves against those things, such as antibiotics, which threaten that survival.
According to the WHO, superbugs account for over 700,000 deaths each year globally; making once easy-to-treat conditions far more tricky.
Before we begin, let’s answer one of the biggest questions surrounding this topic: “What do antibiotics do?” Antibiotics are necessary to fight infectious bacterial diseases in both humans and animals, but are often used for non-life threatening purposes in humans and animals. Aside from their incorrect prescription for non-bacterial infections, the agricultural industry outside of the UK and EU provides antibiotics to livestock to prevent disease and promote growth; many farmers believe that improving the overall health of their animals will produce larger, higher quality yields. But when humans consume by-products of antibiotic-fed livestock, they’re inadvertently ingesting antibiotics, thus leading to a vicious cycle which promotes an environment for drug-resistant bacteria to thrive.
When exposed to these superbugs, we increase our risk of developing an infection that can’t be treated by conventional antibiotics; rendering it potentially fatal. These infections don’t have to originate from some unheard corner of the world, but instead can be a mutated form of a common infection, like a respiratory or wound infection arising from a cold or a cut. This means that minor infections that were once treated using a simple tablet regime could become life-threatening, and even the smallest of surgical procedures could result in disastrous complications, plunging us back to the days where our ancestors feared the common cold.
The result? Extended hospital stays, large bills for the sourcing of highly specialised antibiotics, and an increased strain on front-line healthcare staff, not to mention a far higher risk of death.
Irrespective of GPs or pharmacists diagnosing patients accurately or inaccurately, the issue surrounding inappropriate antibiotic use in the UK stems mainly from the lack of public awareness of the actual function of these medications.
Surveys suggest that nearly half of the UK public believe that antibiotics can be used for the treatment of viruses, and those who attribute antibiotics to the treatment of viral diseases are more likely to (mis)use them. This alarming statistic should be enough to justify the necessity of a clinical assessment before the prescription of an antibiotic; the changes to pharmacy education standards to help maintain the hard work put in place by antibiotic stewardship initiatives to reduce antibiotic prescribing rates, would be a positive step.
As alternative forms of consulting such as the development of online appointments and digital health streamline access to healthcare, this may make antibiotic prescription more likely than in a traditional, in-person clinical setting. Without a physical assessment or appropriate diagnostic testing to confirm the presence of bacteria, physicians may resort to prescribing antibiotics ‘just in case’.
However, the trouble is not whether antibiotics need to be more readily available to the public, but rather ensuring that we are not promoting the growth of resistant superbugs via the delivery and use of these medicines. If we had hypothetically gone down the path Coffey suggested, healthcare professionals would have yet another complication to navigate in the appropriate dispensing of antibiotics.
The evolving nature of the role has equipped many pharmacists, such as those in hospitals and primary care, to diagnose infection and correctly issue antibiotics, yet they are still likely to face pressure from patients for an antibiotic ‘fix’ for whatever ails them.
Regarding antibiotics, UK GPs completed one survey which found that 55% reported pressure to prescribe antibiotics, and a staggering 45% have admitted to prescribing antibiotics for a viral infection despite their knowing that the drug will have no effect on the condition. We need to remind GPs that although patient care is their utmost priority, patient satisfaction should come second to correct treatment advice. Especially when patient satisfaction is only achieved if a GP is to meet the treatment standards dictated by an individual with no medical knowledge.
We need to educate the UK public on what the roles and functions of antibiotics are, especially given the growing dangers of antibiotic-resistant bacteria. Firstly, we’re not talking about adding an obligatory GCSE module to all students’ studies (though given the threat we face, this may not be the worst idea). But due to the significant correlation between patient satisfaction and antibiotics prescription, antibiotic education and further interventions to improve antibiotic use should also be implemented to help rid doctors of the pressures of providing unsafe prescriptions to single-minded patients.
Simply adding educational materials within the clinical setting that can help better patients’ understanding of their condition can go a long way to preventing antibiotic misuse. For example, providing all patients with a patient-information booklet about antibiotics, how and when they should be used, and what happens when they’re misused, is a simple yet effective way of educating patients.
A nationwide antibiotic awareness campaign which focuses more rigorously on the consequences of antibiotic misuse by both healthcare professionals and the general public, could also help to change patient behaviours. The UK supports the WHO Global Action Plan on antibiotic resistance, which aims to reduce unnecessary antibiotic use across the nation, but despite the release of the Antibiotic Guardian and Keep Antibiotics Working campaigns, the message is yet to spread. which aims to reduce unnecessary antibiotic use across the nation, but despite the release of the Antibiotic Guardian and Keep Antibiotics Working campaigns, the message is yet to spread.
We shouldn’t need to emphasise this, but Coffey herself has admitted to sharing her leftover antibiotics with unwell friends and family members; demonstrating her own misunderstanding of the use of these drugs, even when responsible for the health of a nation. This monumental act of ignorance, which is not only illegal, but dangerous to our future wellbeing, may well be interpreted by the UK public as okay. Why? Because the former Health Minister did it.
All medications are prescribed to a patient based on their individual clinical presentations and underlying physiology. Doses of all medications, including antibiotics, work differently in different people, and many antibiotics are prescribed based on specific laboratory results and weight-specific calculations. Since no two people are the same, it wouldn’t make sense to “share” antibiotics with one another. Not only is there a chance that the antibiotic will have no effect at all, there’s also the more catastrophic risk of an overdose, allergy, or medication interaction.
The real implications of facilitating antibiotic resistance will be felt across the globe, with developing countries bearing the brunt of the problem. If we continue to promote this misuse of medicine, we’re looking at around 10 million annual deaths attributed solely to antibiotic resistance by the year 205010 million annual deaths attributed solely to antibiotic resistance by the year 2050; that’s approximately the same number of people that currently die from cancer each year. There’s clearly a demand for quick and convenient access to certain medications but there is a substantial risk of doing more harm than good if these medications are sold without a proper medical assessment. It’s best to leave the prescription of antibiotics to the experts, and let’s not question their motives behind refusing a prescription; they’re just trying to do no harm.