Forget zombies, the antibiotic apocalypse is coming

I HAVE NEVER ADVOCATED that people who routinely feed low doses of antibiotics to livestock should be executed without trial. That would be too harsh, too irrevocable. There should be fair trials, and fines for a first offence, and prison for a second. Only habitual offenders should face the death penalty.

But first, there has to be a law. At the moment, it isn’t even illegal in most countries.

At the United Nations last week, every single member country signed a declaration that recognises the rise in antibiotic resistance as a threat to the entire enterprise of modern medicine. It’s a start, but that’s all it is – and time is running out.

“The emergence of bacterial resistance is outpacing the world’s capacity for antibiotic discovery,” World Health Organisation director-general Margaret Chan warned the meeting. “With few replacement products in the pipeline, the world is heading toward a post-antibiotic era in which common infections will once again kill.”

The declaration urges countries to cut back on the use of existing antibiotics in order to preserve their effectiveness, to make better use of vaccines instead, and to spend more money on developing new antibiotics. It doesn’t put any actual money on the table, however, and it doesn’t even make it illegal to pump “sub-therapeutic” doses of antibiotics into farm animals. (It can’t. National governments have to do that.)

I was not really recommending the death penalty for feeding antibiotics to livestock. That was just for dramatic effect. But the reckless misuse of antibiotics is rapidly destroying their effectiveness.

A recent study by Public Health England found that the proportion of campylobacter bacteria that are resistant to ciproflaxin, the standard antibiotic in cases of food poisoning, has risen from 30 per cent to 48 per cent in just the past ten years. If we don’t stop the rot we are heading back to the 19th century in terms of our ability to control infections. Even minor wounds and simple operations will carry the risk of death.

The same goes for communicable diseases. In the 19th century tuberculosis was the biggest killer of young and middle-aged adults in Europe and America. With the discovery of streptomycin in 1944, isoniazid in 1952, and rifamptin in the 1970s it ceased to be a major health problem. But now the drug resistance has grown so great that at least 190,000 people worldwide died of tuberculosis last year.

The problem of bacterial resistance has been understood for a long time. If the antibiotic kills all the harmful bacteria it targets in the person or animal it is given to, then no resistance develops. But if it only kills off the weaker ones because it was a very low dosage, or because the course of drugs was not finished, then the surviving bacteria will be the most resistant ones.

They will pass their resistance on to all their descendants, who will undergo similar episodes of winnowing out the less resistant ones many more times, and gradually the resistance grows. The only way to keep antibiotics effective, therefore, is to use them as rarely as possible, and to make sure that they kill off all the target bacteria when they are used.

We are not doing this. Doctors over-prescribe antibiotics, often giving them to people who do not have bacterial infections just to get them out of their offices (and sometimes getting a kickback from drug companies for each prescription they write). And nobody makes sure that patients complete the course of treatment even though they already feel better.

Much worse is the widespread practice of giving regular low doses of antibiotics to cattle, pigs and chickens, partly as a means of controlling the spread of disease in their cramped and unsanitary living conditions, but mostly because it makes them put weight on more quickly. Getting them to the slaughterhouse a week or two faster is

money in the hand.

This insanely greedy and reckless practice is now banned in the European Union, but it is still commonplace in China and the United States. In fact, 80 per cent of American antibiotic production goes to farm animals who are not ill, and as intensive farming methods spread to developing countries so does antibiotic use in agriculture.

This has to stop. So does over-prescribing by doctors in developed countries, and the over-the-counter sale of antibiotics without prescriptions that is so normal in many developing countries. “We are now staring at overwhelming evidence of rampant antibiotic resistance, across all ages, all over the country,” said Dr Vinod Paul, head of pediatrics at the All-India Institute of Medical Sciences in Delhi.

We also need a whole new generation of antibiotics to replace those that are hopelessly compromised, which requires persuading large pharmaceutical companies to change their research priorities. (They make more money by developing new drugs that address the chronic health problems of the affluent, so we’ll have to subsidize them.)

It all has to be done, and it has to start now. “On current trends,” said Dr. Chan at the UN, “a common disease like gonorrhoea may become untreatable. Doctors facing patients will have to say, ‘I’m sorry, there’s nothing I can do for you.’”