Antibiotic resistance: a global menace

Should I finish my full course of antibiotics?

That is the question on a lot of people’s minds after a new paper published in the British Medical Journal questioned the antibiotic dogma: that a full prescribed course of antibiotics should be followed through to the end whether or not you’re feeling better.

We have all heard of the term ‘antibiotic resistance’ at some point. Whether it be on BBC news, a groggy 9am lecture or a poster at the GP’s surgery. Yet how seriously has anyone really taken it? Well it is now considered by the WHO (World Health Organization) as one of the biggest threats to global health.

Firstly, antibiotic resistance in simple terms is a mechanism by which bacteria have evolved to avoid being killed by antibiotics in response to their use. Bacteria are constantly evolving and adapting to new antibiotics that are used to kill them. Those that survive a course of antibiotics having acquired resistance to them, will multiply and the next time the same drug is used, its killing or growth arresting method will be ineffective and the bacteria will live. They will either pass on these resistance genes vertically to their offspring or horizontally by transmitting it to other bacteria. Resistance can then spread through sources such as humans, contaminated food and non-human sources. Animal farms and agriculture that use antibiotics as growth promoters abroad, are a major source of antibiotic resistance as poor regulation and use of antibiotics, leads to high levels of transmittable resistance. The overuse of antibiotics medically for humans has also accelerated the process, e.g. in some countries antibiotics are available without prescription leading to misuse.

Common infections such as blood and UTIs, which once easy to treat, have now become the hardest ones. Gonorrhoea, tuberculosis, pneumonia are all getting more difficult to deal with. But who will be one of the first victims in an antibiotic resistant world? Children and neonates that are very susceptible to infections and haven’t yet built a strong immune system. After them, from cancer and immunodeficient patients that are very prone to infections, to your average otherwise healthy female that is likely to get a UTI in her lifetime; all their infections will turn deadly very quickly. Without effective antibiotics, we will be returning to the pre-antibiotic era, when infant mortality was high and a cut could result in limb amputation or even death. Today already, thousands of people die from untreatable infections every year and it is predicted than in 2050 the numbers will reach millions.

Therefore it makes sense that a debate as to whether you need to finish your full course of antibiotics, has arisen. Logically, the longer the course of antibiotics, the more time bacteria have to develop resistance right? Never mind the fact that our progress in fighting against this rising threat has been relatively slow, so people are starting to get nervous.

In this case, the media may have jumped too quickly on the subject. To answer the opening question, the British Society for Antimicrobial Chemotherapy has stated that it would be premature to stop prescribed antibiotic courses early. As with any new data we need more research and more supporting evidence to see if we can extrapolate this advice to everyone. Some however have voiced concerns about antibiotic resistance spreading and getting worse whilst we delay for stronger evidence. Either way, it is good that the topic is being researched further, bringing the scientific community another step closer to winning the fight against what could soon be a war against bacteria.