Time for antibiotics is running out
November 12-18 was World Antibiotic Awareness Week, an annual World Health Organisation (WHO) campaign to increase global awareness of the rapid emergence and spread of antibiotic resistance and encourage best practice amongst health professionals.
WHO stated that ‘‘change can’t wait. Our time with antibiotics is running out’’. Some doctors are warning of ‘‘an antibiotic apocalypse’’ – a world in which most antibiotics have been rendered useless because the bacteria they are designed to kill have mutated and become resistant.
DW TV in Germany reports that if we carry on as we are, by 2050 antibiotic-resistant germs will kill more people than cancer.
The modern antibiotic revolution started with a discovery by Scottish microbiologist and physician Alexander Fleming.
In 1919 Fleming returned from the brutal battlefields of World War I in France where as a medical officer he had witnessed the horrors of sepsis resulting from infected wounds.
In London he took a research job at St Mary’s Hospital. Fleming began his research by investigating chemicals produced by the body’s own immune system. His hope was that they could be used to attack bacteria. At the turn of the 20th century diseases such as meningitis, diphtheria, pneumonia and tuberculosis were major killers.
In 1928 before leaving for a summer holiday in Scotland, Fleming left a bacterial culture growing in a Petri dish in his laboratory.
On his return he noticed that some of the bacteria had vanished to be replaced by a mould. A mould is a fungus that grows in the form of multi-cellular filaments.
The penicillium mould had contaminated the Petri dish and was secreting a chemical that was killing the bacteria. This chemical was the first modern antibiotic. Fleming called it penicillin. He grew the mould in a culture and tested it on his laboratory assistant who at the time had tonsillitis. It worked. However, it was very difficult to grow enough of the mould to be used as a viable medicine.
In 1938 Howard Florey and Ernst Chain, working at Oxford, succeeded in purifying the mould and obtained useful laboratory samples. Florey travelled to the US, taking some of the precious mould with him.
As it turned out Florey’s trip to the US turned out to be extremely fortunate as far as the development of penicillin was concerned because in 1941 the US entered the war and the Americans very quickly realised the potential value of penicillin to cure sick soldiers.
As a result, the US directed its industrial might towards the task of producing penicillin on a large scale. They were so successful that on D-day, June 6, 1944 each of the 75,000 US soldiers involved in the assault on the French beaches carried in his kit an ampoule of penicillin along with a syringe.
Penicillin in tablet form did not come until after the war.
Penicillin became a wonder drug and proved to be highly effective in combating many of the killer diseases of the 20th century. Florey, Chain and Fleming were jointly awarded the Nobel Prize in 1945.
However, penicillin and subsequent antibiotics were overprescribed by the medical profession. The result today is widespread multi-drug antibiotic resistance.
Worse still, in many countries, particularly in Asia, many antibiotics are freely available across the counter and are used for all manner of inappropriate maladies, providing ample opportunity for bacteria to mutate.
Research in many laboratories is currently being directed towards investigating anti-bacterium peptides, chemicals produced by the body’s defence system, and how these peptides can be used to penetrate the bacterium’s cell membrane and disrupt its nucleus.
This is a global crisis. Dr Stephen McBride, clinical head of infectious diseases at Middlemore Hospital in Auckland was recently widely reported as saying that 8 per cent of inpatients at Middlemore have multi-drug resistant bugs in the gut and that in the last 30 years there have been virtually no new anti-gut organism antibiotics.
Disturbingly, multi-drug resistant tuberculosis, a highly infectious disease, is emerging from Eastern Europe. It is fast becoming the leading cause of infectious disease death worldwide. If the antibiotic apocalypse is to be averted the use of antibiotics must be restricted to emergencies only.
If we fail, many more dangerous diseases, not seen for over 100 years, will re-emerge – but mutated and multi-drug resistant.