Is this the end for antibiotics?
Doctors have been blamed for the rise in superbugs as we become increasingly resistant to the drugs that beat them. By Chrissie Russell
Antibiotic resistance is a ticking time bomb. We have fewer new antibiotics being developed at a time when 'superbugs' are becoming more common and less treatable. In yesterday's Irish Independent, we reported on a startling new study that revealed nearly half of Irish GPs were giving inappropriate prescriptions to patients - often powerful antibiotics that may not be needed.
Ahead of Antibiotic Awareness day on November 22, we talk to three experts to find out why the drugs have stopped working, what problems this raises and what can be done to solve the problem.
The HSE has led many campaigns urging the public to only use antibiotics when needed.
But according to Dr Robert Cunney, consultant microbiologist at the Health Protection Surveillance Centre, up to 75pc of antibiotic usage could potentially be avoided.
He explains: "If you look at all antibiotic use, in communities, hospitals and agriculture then between two thirds and three quarters is probably unjustified.
"There's a certain complacency about antibiotics. They're seen as the drug of convenience."
The highest level of antibiotic use – around 80pc – is in the community. Recent studies by the HPSC show that in a typical Irish GP setting, antibiotic use soars by 25pc in winter compared to summer, marking a stark comparison with other EU countries like Holland where there's very little variation.
"It shows we have very close links between antibiotic use and periods of flu activity, respiratory viral infections, antibiotic use rises at that time of year when 'there's a bug going round'," explains Dr Cunney.
"And yet we know that the vast majority of these infections are caused by viruses and antibiotics don't make any difference."
One of the problems is that, in a health system where people have to pay to see their GP, many patients don't like to leave the surgery empty-handed.
"There's a lot of psychology involved in the GP/ patient relationship," says Dr Cunney. "There's often an expectation of antibiotics, people feel 'I've spent €50/€60 – I expect something in return'.
'There's also sometimes uncertainty on the part of the GP who may not have access to a lab service or x-rays," he adds.
"Challenging behaviour, both the patients' and the prescription writers' is difficult, and greater education is needed."
A key element is making sure patients have a better understanding of their ailment. Antibiotics are most frequently unnecessarily prescribed for coughs, colds, flus, sore throats, middle-ear infections in children and cystitis in women.
"We've found that if patients understand how long an illness lasts, it becomes easier to explain why they don't need antibiotics," says Dr Cunney. "People want reassurance. If they know a cough could last up to three weeks it takes away the unnecessary worry that something's wrong."
He adds: "Often the old adage of rest and drinking lots of fluids holds true with respiratory illness and with problems like middle-ear infections, it's often more beneficial to discuss pain management with your GP or pharmacist – antibiotics will make very little difference."
The reason why antibiotic misuse is such a problem now boils down to several reasons.
Firstly, there are fewer antibiotics being made.
Just last month it was announced that stocks of popular antibiotic, Augmentin, could soon run out and be unavailable in Ireland for a year.
Antibiotics are expensive to develop and take longer to develop and test.
"From the pharmaceutical companies' point of view they are more likely to re-coup their investment with drugs for high blood pressure or diabetes, which are more likely to be used by more people for a longer time and are easier to develop, than investing 10 or 20 years developing an antibiotic which will probably only be used for a short time before bacteria develop a resistance," explains Dr Cunney.
"It's a cliché but right now we've almost a 'perfect storm' in terms of bacterial resistance. There are more different types of resistance at the same time as we've fewer new drugs in the pipeline, an ageing population more at risk of infection and greater international travel bringing in new strains of resistant organisms."