This week is the World Health Organisation’s Antibiotic Awareness Week. As part of this, on Wednesday internationally renowned experts in antibiotic resistance will come together for talks at Imperial College London. The event will be hosted by Imperial’s NIHR Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance, led by Professor Alison Holmes, on behalf of the medical journal The Lancet.
One of experts involved in the event, Dr Luke Moore, a clinical fellow from the Department of Medicine at Imperial, says doctors are already battling antibiotic resistance every day in hospitals. He explains that the situation has now reached such proportions that bacteria are even developing resistance to our ‘fall-back’ antibiotics, called carbapenems.
“With the current pace of increasing antibiotic resistance doctors won’t be able to perform any type of transplant surgery. The cupboard will be bare of antibiotics. “
– Dr Luke Moore
Department of Medicine
“Doctors in hospitals across the globe have now reached the point where in many cases they can’t use the most commonly used antibiotics, called first and second-line antibiotics, such as penicillin. One of the scariest things is we are now seeing resistance to our third-line antibiotics, carbapenems. This means doctors are having to look to our fourth and fifth-line antibiotics. But not only are they not as effective, as many can’t get into all the parts of the body where bacteria hide – such as bones, muscles, lungs and brain – but they also have serious side effects such as kidney failure and liver inflammation.
“So at the coalface of medicine, doctors across the world are increasingly having to weigh up the risk of death or serious consequences from each infection, against the serious side effects from the antibiotics themselves, such as the possibility of kidney failure.”
This is just one of many difficult decisions that doctors will increasingly find themselves faced with. Here, Dr Moore reveals how antibiotic resistance could change our lives over the next decade.
CANCER PATIENTS OUT OF OPTIONS
Despite huge advances in cancer treatment, patients may not be able to undergo chemotherapy in the near future. “Chemotherapy knocks out the immune system for a couple of weeks after treatment, as the therapy damages immune cells as well as killing cancer cells,” says Dr Moore.
To protect patients, explains Dr Moore, doctors frequently give them antibiotics immediately after treatment.
“In oncology we’re already seeing high levels of resistance to first and second-line antibiotics, and doctors are having to reach for fourth and fifth line antibiotics earlier than ever before.
“Once we get to the stage where we have no suitable antibiotics, doctors couldn’t knowingly give a patient chemotherapy that will destroy their immune system, when they don’t have anything to save them from subsequent infections.”
The situation will be equally dire for adults and children who need life-saving transplants. These procedures supress the immune system, to stop the body rejecting the new organ – but this leaves them susceptible to infection.
”With the current pace of increasing antibiotic resistance doctors won’t be able to perform any type of transplant surgery. The cupboard will be bare of any antibiotics. This may well happen in our generation.”
RISKS FOR HEART DISEASE PATIENTS
Heart disease is at an all-time high, and is responsible for 7.4 million deaths worldwide. As a result of this, more and more patients are needing heart bypass surgery.
”This important operation may become more risky in the future. Surgical site infections in these patients can already be catastrophic when they occur. But increasing rates of resistance among bacteria that cause these post-operative infections may have serious consequences for the future of heart disease patients.”
JOINT REPLACEMENT INCREASINGLY DIFFICULT
According to a Government document published last year, operations such as joint replacements will soon be too risky to undertake because of the threat of infection. Furthermore, bowel operations – for conditions such as cancer or inflammatory bowel disease – will also be too dangerous says Dr Moore.
“Many of us harbour antibiotic resistant bacteria in our gut. They don’t cause us any harm, as long as they remain in our intestines. The problem with bowel surgery is that these bacteria frequently get into surgical wounds.”
WHAT CAN YOU DO?
Dr Moore cautions patients to never avoid taking antibiotics if they have been prescribed by a health professional. However, it is crucial to take them as directed. Always finish the course – as otherwise this can fuel resistance, and follow the instructions carefully.
”If you’re advised to take the pills three times a day then it’s important to take them at regular intervals. Otherwise you could have low levels of antibiotics in the blood at certain times of the day. This means the bacteria get cosy – there is not enough of the drug to kill them, but enough for them to develop resistance to it. Similarly, if the instructions say take the pills with food, then make sure you do this, as this ensures they’re properly absorbed.”
But on global scale, action is urgently needed. “The pace of antibiotic resistance will be largely determined by how quickly the international community moves to tackle this. At Imperial, we now have the Antimicrobial Research Collaborative, which harnesses our wealth of expertise – and draws on everyone from pharmacologists to evolutionary biologists and data scientists. Collaboration is key, and only by working together can we save modern medicine.”