Antibiotics: A Race Against Time
Alexander Fleming made perhaps the greatest medical discovery of all time in 1929 by discovered penicillin.
But it was left to Howard Florey, a Professor of Pathology together with his assistant, Ernst Chain, to produce enough penicillin to treat the first person. Florey turned his small University department into a penicillin-producing factory, growing penicillin on bedpans. Rooms were specially converted, so penicillin could be incubated, and makeshift pipes carried dangerous fumes throughout the building. The staff worked night and day to produce enough antibiotic to treat one person. Eventually they had enough.
The first patient was Albert Alexander, who suffered from severe abscesses and was expected to die. On being given penicillin he made a remarkable recovery, at least until the fifth day after which the penicillin ran out. He then deteriorated and died. But the doctors knew they had witnessed a miracle. Four more patients were treated later, again with outstanding results.
This discovery transformed medicine more than any other discovery since. The very existence of antibiotics has made us feel safer.
But today a darker picture is emerging. More and more commonly we hear about life-threatening illnesses that have failed to respond to one antibiotic after another. And sometimes these infections prove fatal. In the EU alone, 25,000 people die each year from antibiotic-resistant infections.
Chief medical officer, Dr Sally Davies has become increasingly concerned, talking about a post-antibiotic apocalypse. They are not words to use lightly. She warns us that antibiotic resistance is arguably as big a threat to us as is climate change. But how could things have changed so badly?
Understandably, much of the blame has been aimed at doctors, particularly GPs, for overusing antibiotics. Of course, there is no doubt that over-prescribing has happened. However I know, as a GP, that reducing antibiotic prescriptions is not as straightforward as it seems. Deciding which infections are viral and which are bacterial is far from easy and GPs must always air on the side of caution. Many patients still expect antibiotics, though this is slowly changing.
In fact, GPs have known about this problem for over a decade and have succeeded in changing their prescribing for the better, reducing antibiotic use by about 15% in five years. Not a lot, you may say, but I don’t believe it will improve much more, given the very real difficulties involved. The antibiotics that GPs can routinely use are also restricted, with some stronger ones kept in reserve. In other countries antibiotics are far more available, often without prescription.
But when it comes to the menace of increasing antibiotic resistance, the biggest threat comes from elsewhere. Half of all the world’s antibiotics are used in factory farms. Worse still, 70% of the antibiotics are given, not to treat disease, but simply to promote growth and as a preventative. It is this misuse in factory farms which lies at the heart of the problem of antibiotic resistance.
You might ask why they are being used in this way. The reason is to do with the overcrowded and unhealthy living conditions in which the animals are reared. In these conditions disease spreads like wildfire. To give one example, the risk of salmonella in caged poultry is ten times higher than in their free-range counterparts.
Today 75% of farm animals are factory-farmed (80% in the EU). Both bird flu and swine flu are thought to have originated from factory farms. These farms are the perfect breeding grounds for the incubation and spread of lethal pandemics.
All this could and should have been avoided. An official UK Government inquiry, the Swann report in 1968, recommended a ban on the indiscriminate use of antibiotics. But the government buckled under industry pressure. It took until 2006 for the EU to ban their use for growth promotion and later, in 2016, to ban their use in disease prevention. However it is believed that these rules are being widely flouted. Antibiotics continue to be used indiscriminately in other countries. The problem is the sheer scale of their use. In the USA 80% of all antibiotics are used in factory farms.
MRSA is thought of as the hospital superbug, but community-acquired strains of MRSA can be found in chicken, beef and pig meat. The intensive pig industry is the biggest culprit with half of all pig farmers in Holland carrying the strain as a direct result of the indiscriminate antibiotic usage. In the UK half of all antibiotics given to animals go to pigs and poultry.
Research in 2010 in Korea found six antibiotic residues in the urine of the 500 people tested. These included quinolone antibiotics; these have restricted use in UK general practice. They were found in the urine of those eating beef, pork and dairy products. You can acquire antibiotic resistance just by handling or eating these products.
But there is a further issue. Bacteria are undoubtedly winning the war against antibiotics and it is now inevitable that antibiotic resistance will worsen. Our best hope is to develop new and better antibiotics. However there is a problem. Pharmaceutical companies have shown no interest in developing these, even though antibiotics, more than any other product, helped launch their industry. They know that there is no money to be made in producing this type of drug. Basically any drug that cures a patient is money-loser and they naturally prefer drugs that can be given to large numbers of people for long periods of time (statins, blood pressure drugs) that are highly profitable.
We simply cannot ignore this situation and just hope the pharmaceutical industry will change its mind. My belief is we need a non-profit pharmaceutical company funded by the government, with the remit to find cures. They could research new antibiotics and related drugs. We desperately need this both to protect our own future health and to protect the NHS.
To sum up antibiotics were produced by the untiring, selfless efforts of Florey and Chain who put themselves at risk to make these wonder drugs available to mankind. Sadly this great medical advance has been squandered, notably by the agricultural industry, and we face a world of increasing and potentially deadly antibiotic resistance. If we want to resolve this we must stop the wastage of antibiotics on factory farms and must make finding new antibiotics a priority and it will take the ingenuity shown by Florey and Chain to make this happen.