Tuesday 18 June 2019

10 things you need to know about antibiotic resistance

Antibiotics are lifesavers ­- but their effectiveness is under threat. What can you do to reduce the risk

Take steps to keep your antibiotic resistance strong
Take steps to keep your antibiotic resistance strong

Julia Molony

Antibiotic resistance is a growing problem. The main driving factors behind antibiotic resistance are the overuse and misuse of the drug. So do you know when you need them and when you don't? Here are 10 top tips to help you keep your resistance strong.

1 The threat is real

It's hard to overstate how critical effective antibiotics are to our way of life and what we stand to lose if they are rendered ineffective. In 2016, the British economist Jim O'Neill authored a report that concluded, "if we lose the arms race against bacteria, 10 million lives could be lost globally by 2050." Without action, deaths from superbugs will outstrip the number of deaths from cancer. It is thanks to effective antibiotics that routine surgery, childbirth, dental work and treatments such as chemotherapy can be considered safe. They are a precious resource and one that is gravely under threat. According to Dr Margaret Chan, the former Director General of the World Health Organisation, (WHO): "A post-antibiotic era means, in effect, an end to modern medicine as we know it."

2 The problem is evolving all the time

At the end of last year it was reported that the number of patients diagnosed with the superbug CPE (carbapenemase-producing Enterobacteriaceae) in Ireland had almost doubled compared to the previous year. CPE is defined by the WHO as representing a serious risk to patient safety, and is particularly feared because it is immune to some or all of the antibiotics of last resort. The Minister for Health classified the rise in cases as representing a public health emergency. But CPE is just one of an emerging generation of superbugs taking hold in Irish hospitals.

3 Antibiotic resistance is evolution in action

Bacteria are adaptable and hardy organisms, capable of altering their genetic structure rapidly in order to thrive in all environments on earth. When we attack harmful bugs with antibiotics, the hardiest amongst them will survive and multiply. Those surviving bacteria have an evolutionary advantage and as they reproduce, they pass on that advantage to the next generation. Over-use of antibiotics actually selects for antibiotic resistance - the more we use antibiotics the more we create favourable conditions for resistant bacteria to thrive.

Since antibiotics revolutionised healthcare in 1945, we've taken them for granted.

"We all thought this was not going to end, that antibiotics were this wonderful thing and we had won the war against infection," says Dr Nuala O'Connor, a practicing GP and The Irish College of General Practitioners Lead for Antibiotic Resistance. "And so patients in the community as well as doctors were lulled into this false sense of security. . . Doctors knew they were overprescribing, but we didn't realise the harm that could come from overprescribing. Now we know that in many instances we don't need to use antibiotics because the patient probably has a viral infection rather than a bacterial infection."

4 Ireland's record on tackling the problem isn't brilliant

"We're not the worst, but we could be better than where we are," says Dr O'Connor. "If you look at the figures for antibiotic use in human consumption, we would be in the top third of antibiotic use in Europe. The lowest use would be in the Scandinavian countries. Our vets are very much better and they would be in the bottom third with regard to European use." Containing and limiting the use of antibiotics in animals and especially in industrialised farming is of equal importance in addressing the problem of resistance. But the government has begun to take this issue seriously and last year, it published its National Action Plan for Antimicrobial Resistance.

"We are seeing green shoots of improvements," says Dr O'Connor. "Our overall use of antibiotics in 2017 has decreased, and our overall use of broad-spectrum antibiotics is decreasing. The number of antibiotics that are being prescribed per 1000 of population is falling, particularly in people under 16 and young adults."

5 The Way Your GP prescribes antibiotics is changing

GPs still rely largely on making a clinical judgement on whether a patient is suffering from a viral infection - for which antibiotics have no effect - or a bacterial one. "Sometimes it's quite obvious to your GP whether you are suffering from a bacterial or viral infection, but other times it's less clear and requires a judgement call," says Dr O'Connor. Where they once might have prescribed antibiotics "just in case" they are likely now to be more circumspect and perhaps wait to see how your symptoms evolve. "We're trying not to do harm, but the trade-off with that is sometimes people will get a little bit sicker before we will institute the antibiotic," she adds. "We ask the public to come on board with us to understand why we prescribe sometimes and why not in other cases."

You may have been used to getting an antibiotic for something, but things are changing, says Dr O'Connor, who gives the example of the common ailment, sinusitis. "We now know from studies and investigations is that only about 2pc of sinus infections are actually bacterial. The vast majority are viral."

6 It's good to ask questions

"Ask your GP, do I really need this antibiotic? Do you think it's a viral or a bacterial infection? Can I hold off for a few days? Something we sometimes use is a deferred prescription," says Dr O'Connor. It's also worth asking about the particular drug you are prescribed, she explains, with GP's now favouring "narrow spectrum" antibiotics that attack only the specific bacteria causing the infection rather than a "broad spectrum" one which takes a carpet bomb approach. If you are prescribed antibiotics, it's important to always take them exactly as prescribed, she adds.

7 Preventing the spread of infection is key

The fewer infections that are contracted, the fewer antibiotics will be prescribed. That means washing your hands regularly and thoroughly, as well as practicing what Dr O'Connor calls "good cough and respiratory etiquette. The best thing to do is practice coughing into your elbow or tissue and binning it. Turn away from people and cough into your elbow, particularly when you are around vulnerable people," she says, adding that we have to accept that "our hands are contaminated a lot of the time. People often ask me at work, why don't I pick up infections. And I say one thing I do is I train myself to keep my hands away from my face. I know that one of the main ways that people pick up bugs is that they've touched a surface with bugs on it, and then they're hands are dirty and they actually contaminate themselves."

8 New drugs are not a silver bullet

While Jim O'Neill's report placed emphasis on incentivising drug companies to develop a new generation of antibiotics, they are unlikely to represent a solution. "Experts believe that the current antibiotics we have are probably the best we'll ever have," says Dr O'Connor.

"There may be completely different advances," she says, and completely different types of drugs. "It may not be antibiotics, it may be other ways to actually combat bugs. But we really have to be extremely careful about how we use, and preserve the effectiveness of the antibiotics that we currently have. And there are ways that we can do that."

9 A simple blood test may become part of your GP consultation

One area of hope for real progress in the fight against antibiotic resistance is the development of rapid diagnostic tests which can be carried out in-surgery by GPs. "By 2020 it should become mandatory to use rapid diagnostics before antibiotics are prescribed," wrote Jim O'Neill in his 2016 report.

"The technology is there," adds Dr O'Connor who has been campaigning to institute widespread availability of tests for a marker called C Reactive Protein, which help a physician distinguish more clearly between a viral and bacterial infection, to be made available to the Irish public. "It is actually being actively looked at in terms of the economic analysis for it. And it is introduced in other countries," she says. "If I did that test it would give me a probability factor. Above a certain value, yes, much more likely to be a bacterial infection, so I'd know, go for the antibiotic. Below a certain value, much more likely to be a viral infection. I still have to monitor the patient, but I'm much more confident and the patient is more confident."

10 You can help by helping yourself

Instead of expecting a prescription when you head to the doctor, there are important self-help measures that you can take to aid your body in its fight-back against infection. "People have forgotten that sometimes you need a bit of rest," says Dr O'Connor. "If you are fighting an infection you need to take a bit of time out, a bit of rest, plenty of fluids. Eat a little if you can. And the other thing to remember is that antibiotics don't do anything for pain, or for fever. What you need for those is rest and over-the-counter medicines to relieve symptoms."

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