Thursday 18 January 2018

No ready cure for our overdependence on antibiotics

Infections are becoming increasingly resistant to antibiotics (stock photo)
Infections are becoming increasingly resistant to antibiotics (stock photo)
Eilish O'Regan

Eilish O'Regan

The start of summer is not the best time to grab people's attention about our continuing overuse of antibiotics - drugs we normally associate with the cold and flu season.

But the stark warnings are ever more urgent, in major reports about common infections becoming killers because so many of these drugs will stop working.

Last week, the UK's "superbug tsar" Lord Jim O'Neill, delivered his verdict on the medical crisis to Prime Minister David Cameron.

It said severe infections will kill one person every three seconds by 2050.

Ireland in particular needs to take heed. We are already ranked 'mid-to-high' in the European league table for antibiotic use.

The reality is that more infections are already becoming resistant to antibiotics at worrying speed, causing problems for hospitals and GPs across Ireland in fighting superbugs like MRSA.

The miracle drugs treat everything from minor infections to life-threatening illnesses like pneumonia.

But the germs have learned to adapt, due to factors such as over-prescribing of antibiotics and patients not finishing their course of treatment.

Last year there was a slight increase in Irish hospitals in the use of "last resort drugs" which should be used more sparingly to stay effective in treating serious infections.

A major university teaching hospital looking after large numbers of critically ill patients with complicated diseases will tend to use many more antibiotics than one that mainly looks after the less seriously ill.

Irish hospitals use on average just under one dose of antibiotic for every patient in the hospital. This does not mean that every patient is on antibiotics. Some patients may be on three at the same time.

The problem is complex, and in our maternity hospitals the numbers of antibiotics given to women are on the rise.

This is due to guidelines on the treatment of sepsis, a form of blood poisoning triggered by infection, which if untreated, can lead to multiple organ failure.

These were introduced following the death of Savita Halappanavar.

In the past, doctors would have monitored the patient over time but now it is much more difficult not to start them on antibiotics. It does mean that more of these women are checked over 24 to 48 hours, and may have their treatment changed.

Overall concern relates to the continuing rise in the use of critically important groups of penicillin, cephalosporins, carbapenems and quinolones.

Although MRSA is the best known superbug, Irish patients are also at risk from Clostridium difficile, MDR-TB and carbapenemase-producing Enterobacteriaceae(CPE).

Clinical judgement still plays a huge role in a doctor's decision on antibiotics, and they can err on the side of caution.

Lord O'Neill suggests that rapid testing of patients should be carried out to determine if their infection is due to a virus or bacteria before any antibiotics are prescribed.

But a cheap and quick test has yet to be invented.

Irish Independent

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