Alexander Fleming, who discovered Penicillin warned in his Nobel Prize acceptance speech in 1945 ‘there is a danger that ignorant man may easily under dose himself and by exposing his microbes to non-lethal quantities of the drug, make them resistant’. (1) Sadly he was right, we have literally been ingesting, spraying and washing much of our planet with anti-biotics for 50 odd years. Terms such as superbug, hospital infections and MRSA are now familiar to all of us, but Anti-biotic resistance is not just found in hospitals, it is found in wild animals and in rivers, it’s everywhere.
The cause of the resistance is inappropriate overuse. In 1943 we had 32 litres in Penicillin available in the world, by 1999 use of anti-biotics in the US alone was 40 million pounds annually. Anti-biotics are being used to treat humans, animals and agriculture crops, indeed anti-biotics are routinely in the feed of mass farmed animals. They are found in anti-bacterial hand washes and cleaning products to (2). Anti-biotics work to kill bacteria, not just bacteria that is causing us problems, but also good bacteria, which is why some patients take pro-biotics whilst on anti-biotics to protect their gut flora (3). Each year 50,000 pounds of streptomycin is sprayed on US fruit trees and this having an effect on the good bacteria in the soil (4). In his book ‘When Antibiotics Fail’ Marc lappe states ‘we have let our profligate use of anti-biotics reshape the evolution of the microbial world…upsetting the balance of nature’ (5).
Major discoveries like penicillin saved many lives from infection, however the last new class of anti-biotic drugs were developed in the 1980s and since this time we have had what is described as a ‘discovery void’. During this void, anti-biotic resistance has grown. In healthcare settings, resistance means difficulty in treating UTIs, pneumonia & bloodstream infections, particularly in seriously ill and post-operative patients. Treatment failures due to resistance from treatments of last resort for gonorrhoea have now been reported from 10 countries. The WHO states Gonorrhoea may soon become untreatable as no vaccines or new drugs are in development (6, 7).
The global anti-biotic approach to combating infection is demonstrably flawed, because it has led to resistance. The discovery void must be whole heartedly filled with the pursuit of finding a myriad of anti-microbials, not just one or a class of them. Local initiatives to combat infections and microbes in different settings and geographies would be pertinent. The substances used to treat fruit trees should be different than the one used to treat man. The pursuit must be ongoing, as it is now time to accept that there will be no point where ‘we have cracked it’, we made that mistake with Penicillin, dare we make it again? Science is essentially the pursuit of knowledge not proof of knowledge.
What are the Solutions to anti-biotic resistance?
Prescribe less anti-biotics: In Europe, Greece has the highest per capita use of antibiotics, and The Netherlands has among the lowest. One study found the proportion of S. aureus isolates that are methicillin-resistant was 58% in Greece compared to 1.6% in The Netherlands (8). So evidently anti-biotic misuse and resistance go hand in hand.
Policy and Regulation: At present regulations are variable, but focused mainly on healthcare, there is no joined up strategic thinking. The EU Action Plan against antimicrobial resistance (AMR) recognised this, stating ‘To tackle antimicrobial resistance, a holistic, multi-sectorial approach, involving many different sectors (human medicine, veterinary medicine, research, animal husbandry, agriculture, environment, trade and communication) is needed. It is only by taking action in all of these areas simultaneously that further spread of resistance will be limited and antibiotics kept effective.’ (9)
Develop test kits: Part of the challenge is misidentification of microbes, fast screening could prevent inappropriate prescriptions of anti-biotics. There is a technology race on and medical device companies would do well to develop such products. The European Commission has funded a 36 million euro project to try and develop testing technologies (10). The UK Technology Strategy Board and Nesta have set up The Longitude Prize, the winner is to develop a point-of-care diagnostic test to identify when antibiotics are needed and, if they are, which ones to use. The prize is £10 million (11).
Find new and old anti-microbials: Our species has perhaps congratulated ourselves unduly for our 60 year old use of anti-biotics to combat infections, whereas the natural world has been fighting microbes for a millennia and a search for answers from natural world may be one solution. Researchers at the North Eastern University of Boston, have been studying potential of microbes in the soil as new anti-biotics by growing them not in a petri dish but in the soil itself, their ground-breaking research has been published in Nature (12). Plants have many natural anti-microbial properties, as described excellently by Steven Buhner’s book ‘Herbal Anti-biotics’, which also promotes herbals for strengthening the immune system, so our bodies are better prepared. The anti-microbial properties of Essential oils have been exhibited in numerous studies (13). One such study demonstrated that 10 essential oils showed a higher effectiveness at fighting MRSA than the standard anti-biotic treatment, vancomycin (14). Keeping our hospitals superbug free is also a challenge, technological advances, such as using copper as a material coating application due to its anti-microbial properties is one of many potential solutions (15).
1) Alexander Fleming, Penicillin, Nobel Lecture, December 11, 1945, http://www.nobelprize.org/nobel_prizes/medicine/laureates/1945/fleming-lecture.pdf
2) Steven Harrod Buhner (Aug 2012) Herbal Anti-biotics, Storey Publishing; 2nd Revised edition
3) NHS Info leaflet: Anti-biotics and Pro-biotics http://www.stockport.nhs.uk/documents/PIL/43070_LAB95.pdf
4) David Heyman (Dec 2014) Working across sectors: a public health approach to antimicrobial resistance (WHO Presentation, Murdoch University, http://www.slideshare.net/MurdochUniversity/perth-amr-david-heyman
5) Marc Lappe (1995) When anti-biotics fail-restoring the ecology of the body, North Atlantic Books; 1 edition
6) Sherwood L. Gorbach, John G. Bartlett, Neil R. Blacklow (2004) Infectious Diseases, Lippincott Williams & Wilkins
7) WHO 2014 ANTIMICROBIAL RESISTANCE Global Report on Surveillance http://apps.who.int/iris/bitstream/10665/112642/1/9789241564748_eng.pdf
8) Bartlett JG, Gilbert D Spellberg B. Seven ways to preserve the miracle of antibiotics. Clin Infect Dis. 2013;56:1445-1450. Abstract
9) European Commission/ DG Health and Food Safety/ Public health/ Antimicrobial resistance
10) An Integrated Tool-Kit for the Clinical Evaluation of Microbial Detection and Antibiotic Susceptibility Point-of-Care Testing Technologies Project, http://www.tempotest-qc.eu/index.php
12) Ling et al (Jan 2015) A new antibiotic kills pathogens without detectable resistance, Nature, pp 455-459, http://www.nature.com/nature/journal/v517/n7535/full/nature14098.html
13) Maggie Tisserland (2011) Aromatherapy Vs MRSA, Antimicrobial Essential Oils to Combat the Superbug, The Clarity Press
14) Shurma, p et al (July 2012) Ten highly effective essential oils inhibit growth of methicillin resistant staphylococcus aureus (MRSA) and Methicillin sensitive staphylococcus aureus (MSSA), International Journal of Pharmacy and Pharmaceutical Sciences, Vol 5 (Issue 1) 2013, http://www.ijppsjournal.com/Vol5Issue1/4863.pdf