Antibiotic Resistance

Yes, it's true. There is a danger of widespread catastrophic failure of antibiotics in the future, as stated on our radios this morning by Sally Davies. I think it is sometime off however, but here's what antibiotic resistance is all about, why it happens and what can be done to prevent it.

What does antibiotic resistance mean?

There is a feeling that "natural" things are good and "synthetic" things bad. This is why the processed food story is so appealing. Sorry, but this is simply not true. Bugs ("pathogens", bacteria, virus and fungal infections) are all totally natural and they are out to get us. Also, many natural plant extracts and animal "secretions" are poisonous without any known medicinal use. Antibiotics on the other hand are our allies. They generally derive from a natural substance, but they are then chemically synthesised in a lab. They attack bacteria in one or more of a range of possible different ways. Some attack the bacterium's cell wall (it's skin if you like) and others stop them reproducing etc etc. But they evolve. And they evolve really fast. Or the adapt and any rate like the Borg in StarTrek. When they adapt, they can withstand the attack by the antibiotics and you have to switch to a different antibiotic to get'em!

Why does it happen?
Well there are two levels to this question. "Biologically" what happens and "therapeutically" what happens. Biologically first. As I said above, it's like a kind of evolution. The genetics of bacteria change really fast and so the unfit bacteria perish and the strong ones survive. So "unfit" means unfit to fight that particular antibiotic. Get a dish of bacteria and they are constantly mutating subtly. Some mutations make them stronger, others make them weaker. This just happens. there is not much we can do about it. Then add your antibiotic to the dish: Most of the bacteria will be killed, but a few will survive, that's inevitable. BUT, here's the rub... the ones which survive will obviously be the ones who have a genetic mutation which makes them slightly better at resisting the antibiotic. Now take those survivors away, grow them up and hit them again with the same antibiotic: What would you expect? ...well the antibiotic will kill many of them, but now those strong survivors have multiplied and a large proportion of them will now survive. Take these survivors, do the same again and you have a superbug! Congratulations! ...you've moved closer to the end of mankind :-/
So medically/therapeutically how does it happen: You don't use a dish you use a person. You give a person with an infection an antibiotic and enough will be killed to make the person feel better..... but there may be a few bacterial survivors. These spread on to the next person and the experiment above is recreated in a real person rather than a dish and you are creating superbugs. Simple as that.

What can be done about it?
Well sure, invent new classes of antibiotics which work in entirely different ways to the current ones. Thanks Sally! But that is the hard way. The easier ways are these:
(1) Don't ask for antibiotics unless you really need them! (Clinicians should not give them to you even if you ask unless it really is necessary). There are frequently alternatives. Usually infections passes. If its a cold or flu antibiotics won't work anyway, because they are viral. Antibiotics only work on bacteria. You always think they work, because by the time you get the clinician to give you the drug you are just starting to get better anyway (yes even though you don't feel any better yet).
(2) Don't give them to animals to increase farming yield. Use better animal husbandry instead. If you cram your chicken (for example) into ridiculously tight spaces so infections spread by wildfire and then load them up with antibiotics "just in case".... you are not just being cruel to the chicken you are going to end up killing people. Yes you are!!!
(3) Finish your course of antibiotics if you do get them. People frequently get a course of antibiotics and stop taking them when they feel better. Its innocent enough, but this is a huge problem, It massively increases the chances of strong bugs surviving and going on to spawn a new generation of superbugs. If you read down this far and want one message its this, please please please, a thousand times please finish your meds!!!!