This year, antibiotics were voted Britain’s greatest invention by the public in a TV collaboration between the BBC and the Science Museum. And it’s true: antibiotics really have changed the world. Antibiotic use has its downsides though, the major one being antibiotic resistance and the rise of the ‘superbug’. A new exhibition at the Science Museum in London, Superbugs: The Fight For Our Lives, which opened yesterday and will run until Spring 2019, looks at this issue in more detail. It’s a brilliant exhibition, and well worth going to see if you can. I went yesterday, and really enjoyed it.
In order to understand and solve the problem of superbugs and antibiotic resistance though, we first need to understand how antibiotics work, and how superbugs come to be.
There are millions of species of bacteria in the world, and they travel further and faster around the globe than pretty much any other living organism. You will have trillions of bacteria living on and in your body, outnumbering your own cells by as much as 10 to 1! Many bacteria are completely harmless, and some are even beneficial (the bacteria in your gut, for example). Some, however, can be really dangerous to people.
At their most basic, antibiotics are chemicals which can kill bacteria or affect or prevent their function in some way. ‘Antibiotic’ literally means ‘against life’ (from Greek anti- meaning ‘against’, and biotikos ‘pertaining to life’, from bios ‘life’). Generally, they are produced by bacteria and fungi, however there are also semi-synthetic antibiotics which have been derived from those chemicals produced directly by the bacteria and fungi. The ancient Egyptians (and possibly other early civilisations) treated wounds and skin infections by applying a poultice of mushed up mouldy bread! Antibiotics do one of two things to bacterial cells: some break bacterial cell walls which causes the cells to burst open, while others prevent the bacteria from producing all of the proteins and/or DNA necessary for them to survive and reproduce.
Possibly the most famous antibiotic is penicillin, discovered by Alexander Fleming in 1928, and developed a decade later in labs here in Oxford by Ernst Chain and Howard Florey. The trio were awarded the Nobel Prize for Medicine in 1945 for their role in developing antibiotics. Fleming also predicted the problem of superbugs in 1945 – even that long ago, he could see the potential for this problem!
Antibiotic resistance arises when bacteria become resistant to antibiotics – that is, the antibiotics become ineffective against (some of) the bacteria. Usually this is due to a random mutation in a small number of bacteria. The problem is that these bacteria are not then killed by the antibiotics, and live to reproduce. Over time, across a large population of bacteria, all the non-resistant bacteria will be pretty much wiped out, leaving only the resistant strains – the ‘superbugs’. If someone becomes infected with one of these resistant strains, there are fewer antibiotics available to treat them, and more powerful antibiotics need to be used. Of course you can probably see the problem here: over time strains of bacteria resistant to these more powerful antibiotics will develop, and there will be even fewer treatment options available. We are already starting to see infections which do not respond to any of the antibiotics we have available; in these cases, the infection can be fatal.
Superbugs are bad, not only because people will catch infections that can’t be treated, but also because it makes it really difficult for hospitals to control the spread of bacteria, and for farmers to treat livestock when they are ill. New antibiotics are hard to find, and once found, the process of turning them into a medicine is very expensive – and then scientists need to find ways to produce the antibiotic relatively inexpensively and on a commercial scale. In the last 30 years, there have been no new antibiotics approved for use in humans.
Today, antibiotic resistant bacterial infections kill around 700,000 people a year across the globe. By 2050, that number could be more like 10 million people. (To put those numbers in context, in 2016 the population of the UK was about 65.5 million people, and the population of the world was about 7.6 billion. 10 million people is a lot of people.)
What can you do to help?
One of the biggest problems is over-prescription. 90% of GPs report feeling pressured by patients to prescribe antibiotics, and nearly half of GPs have found a patient so demanding of antibiotics that they have felt they had to prescribe them. In the UK alone, this leads to up to 10 million unnecessary prescriptions of antibiotics every year. Antibiotics only work on bacteria. They do nothing at all for viral infections, like colds and flu. If you have a cold or the flu, you don’t need antibiotics, so don’t ask for them!
Over 20% of patients don’t take their antibiotics correctly. This can include things like not finishing the course, or not following the instructions for when and how to take them. The problem with this is that you can get weakened bacteria who aren’t yet dead but have been exposed to the antibiotic, and these can develop into superbugs. 40% of 15-24 year olds have also taken antibiotics that weren’t prescribed to them, which can lead to similar problems. It’s really important to remember that you should always finish the full course of antibiotics, even if you are feeling better, and not to take any sort of prescription medication that hasn’t been prescribed to you!
Next week, carrying on this theme, I’ll be talking about the future of the superbug, and how scientists are trying to solve this problem.
For teachers, the WHO has a lot of really useful resources on their website.