Antibiotic Resistance

By Elyse Popplewell

The threat that’s estimated to cause 10 million human deaths by 2050 isn’t inherently evil, or even particularly scary at its core. “One of the biggest threats to global health, food security, and development today,” according to the World Health Organisation, is caused by too much of a good thing. It’s too much antibioticstoo often, too easily, too unnecessarily, and too wastefully.

This is the rise of the ‘superbug’a phenomenon where bacteria is resistant to multiple antibiotics. Bugs growing a resistance to antibiotics will happen naturally, but our misuse of antibiotics in both humans and animals is accelerating the process, and leaves all of us at risk.

In 2017, a woman from Nevada, US, died of an infection resistant to 26 types of antibioticseven those developed as a last resort. She contracted the infection overseas, and it seemed no combination of modern medicine could fight the superbug. This is not the first, nor the last, death caused by antibiotic resistance.

When your doctor insists on you finishing the course of antibiotics rather than dismissing it three days in because you feel better, it’s for a reason. The bug takes a strong enough beating to get rid of your symptoms, but without annihilating it all together, your early-mark on the antibiotics gives it a chance to grow resistance. In saying this, as antibiotics develop, there has been a growing controversy about short-term versus long-term antibiotic courses.

In this century, medicine is a team sport. The most responsible thing to do is to not pressure your doctor for antibiotics, and if you are given them, ask what to do if you feel better before the full course.

There’s two more major ways we contribute to antibiotic resistance that you probably don’t realise. Dr Christine Carson, Research Associate at the School of Biomedical Sciences at Western Australia University explains.

“We’re all a part of the modern food chain, and at the moment that food chain uses tonnes of antibiotics around the world every year.” So, aside from the vegans amongst uswe all have a role in this industry practice.

“We have tonnes of thousands of chickens being raised in a shed. If one bacterial infection gets in there, the whole shed gets wiped out. So, at the first sign of symptoms, they probably all get treated with antibiotics.”

It is not human or animal bodies that become resistant to antibiotics, it’s the bug. Any of these bugs could be transmitted to humans via animal-sourced food, animal waste, or the animal’s surrounding environment. In 2017, WHO declared “There is clear evidence of adverse human consequences due to resistant organisms resulting from non-human usage of antimicrobials.” A greater and imprudent quantity of antibiotics fed to animals leads to a greater likelihood of bugs growing resistance. In turn, through food consumption or other transmission routes, humans are at a greater risk.

Washing your hands thoroughly with soap helps prevent the spread of germs and bacteria. But is a humble bar of Pears soap as good as the anti-bacterial soap that swears to kill 99.9% of germs? Well, probably.

“Plain soap and water does equally, literally equally, the same job at cleaning your hands and potential harmful bacteria. But, plain soap won’t up the ante in terms of promoting antibiotic resistance” explains Dr Carson.

The common inclusion of Triclosan, an antibacterial ingredient, in domestic hand soaps is redundant, and the Food and Drug Administration in America outlawed its inclusion in commercial soaps in 2016 on the basis that there wasn’t enough evidence to say Triclosan and similar ingredients made a safe or effective impact on cleaning hands. Despite this, Triclosan still exists in many commercial hand soaps in Australia.

So while it seems like this is all fairly minor and cumulative effects now, and we’re experiencing a low number of about 700,000 annual deaths caused by antibiotic resistance, it’s predicted to be a greater and more-difficult-to-treat threat to humankind than cancer. Procedures that are common and usually fairly safe, like a mole removal or a caesarean, could become a life-threatening practice. Open wounds of any kind can easily become a site for infection, and when we’ve exhausted the powers of common antibiotics, we don’t have much other ammunition in stock.  

“It’s going to change the way we do modern medicine. It completely alters the risk/benefit factors of any procedure,” says Christine. “As long as you’re healthy, they won’t bother you.”

But, of course, not everyone in society is fit and healthy. Babies, elderly people, pregnant women, or people with impaired immune systems are more susceptible to these superbugs. Much like fifth year UTS Communications and International Studies student Liam Cormican, who has Crohn’s disease.

Liam believes he was travelling in Greece and “Sleeping in gross hostels” when he contracted superbug Clostridium difficile, or C-diff for short. Only seven months into his year abroad in Spain, Liam thought his symptoms were a really bad Crohn’s disease flare up. He bypassed a trip to the local hospital and booked a flight home ASAP.

“It’s really hard to explain how bad I got it. I had really bad constipation, pain, and bleeding. Whenever I had to go to the toilet it was like I was shitting glass.”

This is an anaerobic bacterium, which means it doesn’t grow in the air, so its sensitivity to antibiotics is difficult to ascertain because you can’t put it in a 37-degree incubator like you would to analyse a less unique bacterium. Although C-diff isn’t completely antibiotic resistant, it’s difficult-to-treat nature raises an interesting point about treating disease in a post-antibiotic stage, as well as why creating new antibiotics isn’t a viable solution.

No new classes of antibiotics have been developed for decades. In fact all antibiotics brought onto the market in the last 30 years are variations of existing drugs. Antibiotics that safely attack bacteria without being toxic to a human are complex to manufacture, and not necessarily an appealing investment for a pharmaceutical company if it’s going to be kept on a reserve shelf more as a last resort than a typically simple UTI Cephalexin fix.

In the end, Liam was cured of his illness thanks to a faecal transplant. Antibiotics could help lessen the effect of C-Diff, but couldn’t quite destroy the bacteria. Liam’s experience is likely to become more common in an era of easy-travel and antibiotic resistance. Fortunately, leveraging medicinal procedures that aren’t purely prescribing antibiotics, like a transplant in Liam’s case, are options for some infections. But not all.

Now, medical professionals, governments, and consumers are beginning to put awareness for this endemic at the forefront of discussions, policies, and personal decisions.