Antibiotics overuse is threatening to kill 10 million people by 2050. This is according toThe Review on Antimicrobial Resistance, chaired by UK economist, Lord Jim O’Neill.
The report further states that there will be more people dying from antimicrobial resistance in the future than people dying of cancer.
The reason? Many antibiotics that were used to cure infectious diseases are no longer effective. The organisms that are resistant to antibiotics, have been termed “superbugs”, and the World Health Organisation (WHO) has already warned that these are set to cause a new epidemic.
South Africans need to understand that antibiotics cure bacterial infections and not viral infections such as colds or the flu.
In South Africa antibiotic resistance is being driven by the incorrect use of antibiotics by people suffering from the cold, said Prof Marc Mendelson, Head of Division of Infectious Diseases & HIV Medicine at the University of Cape Town and Groote Schuur Hospital.
“The majority of unnecessary and over-prescribing of antibiotics happens when people go to their family doctor when they have a common cold, which is caused by a virus,” he told Health24.
“Also in the hospitals, we as healthcare professionals are using too many antibiotics inappropriately and this leads to more resistance. We therefore need to be very clear about when we use antibiotics and if it is correct.”
Prof Mendelson said antibiotic resistance is a complete game-changer for modern medicine. “It is the largest public health threat potential that we face currently.”
Drug-resistant infections is already a major problem in South Africa and it is getting worse, warned Prof Andrew Whitelaw, head of the Division of Medical Microbiology in the Faculty of Medicine and Health Sciences at Stellenbosch University.
“In hospitals, many of the bacteria (up to 60 or 70% in some centres) are resistant to most available antibiotics, leaving only one or two options available for treatment,” he told Health24.
“We are also seeing bacteria that are resistant to all available antibiotics and that are essentially untreatable. Fortunately this is still relatively uncommon (compared to some other parts of the world), but the problem is likely to get worse.”
This is exacerbated by the fact that there are few to no new antibiotics coming onto the market, said Prof Whitelaw. “What is coming out is usually a modification of an existing antibiotic, rather than a completely new antibiotic. Resistance to these modified antibiotics tends to develop fairly quickly.”
Although there is no formal definition of how many antibiotics an organism needs to be resistant in order to be defined as a “superbug”, some of the common ones are Staphylococcus aureus resistant to methicillin (MRSA); carbapenem resistant Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii.
One of the other major interventions is to improve infection control in hospitals, pointed out Prof Whitelaw. “If we can reduce the number of patients who get infected with these so called superbugs, we will need to use fewer antibiotics, and prevent the mortality and morbidity associated with treating hospital acquired infections.”
However, Prof Whitelaw added that in the community setting, antibiotic resistance is also emerging, but not yet at the level seen in hospitals.
For instance, resistance to oral antibiotics in gonorrhoea has led to the need to give injections for this condition. “If resistance to the injectable antibiotic becomes widespread then we are going to be faced with a problem of how best to treat gonorrhoea.”
What should ordinary people know about these so-called superbugs?
Maybe the best message for everyone would be not to pressure doctors into prescribing an antibiotic, Prof Whitelaw suggested.
“If your doctor doesn’t prescribe antibiotics, then you don’t need them! And if you do get antibiotics, please don’t share them with your friends/neighbours etc.”
Said Prof Marc Mendelson: “The key issue is that the more antibiotics you use the more resistance develops and the more superbugs develop, so we have to ensure that we use antibiotics only when that antibiotic is necessary.”
He said patients need to have proper conversations with their doctor and ask if they really need an antibiotic. “If the answer is no, then do not take that antibiotic because all it is doing is harm to you, your family and the population by spreading and increasing resistance.”
When should antibiotics be prescribed?
Antibiotics should be prescribed when there is a proven bacterial infection (identified through laboratory investigations). Where there is a strong clinical suspicion of a bacterial infection and there isn’t time to do laboratory testing, empirical treatment with antibiotics is also appropriate.
In addition, antibiotics should be prescribed to patients who require prophylactic treatment – for example, a patient with rheumatic fever who requires a dental or surgical procedure.
Patients should also stop demanding antibiotics when it isn’t necessary, cautioned Prof Mendelson, adding that people suffering from a cold or present a flu-like illness don’t need to go to the doctor to get antibiotics. He recommended that people rather get vaccinated to prevent infections.
“If you vaccinate against bacterial diseases then you stop yourself from getting that bacterial disease and you stop the use of antibiotics. If you vaccinate against diarrhoeal virus diseases or influenza, you stop GPs and family practitioners and other doctors giving antibiotics inappropriately. Vaccinations are a huge part of this and are very important to prevent infection.
“The other thing that the general population need to understand is that hand hygiene and cough etiquette form a very important part in reducing the spread of bugs.”
He said those who are ill shouldn’t cough openly onto people, but rather into their elbow to limit the spread infections to other people.
When should doctors not prescribe antibiotics?
“We know antibiotics can be lifesaving – so it’s not about never prescribing antibiotics. But doctors need to be far more aware of the fact that every antibiotic prescribed creates a little bit of extra selective pressure, and drives the development of resistance,” said Prof Whitelaw.
“The message we are trying to out across is that antibiotics should be used only when there is a confirmed (or strongly suspected) bacterial infection; when used they need to be given at the right dose, and should not be given for excessive periods of time. Doctors cannot carry on prescribing antibiotics on the assumption that they are safe and harmless and it’s OK to use them ‘just in case’.”
Bonitas Medical Fund suggested that everyone stop treating antibiotics like sweets and allow their immune system do what it is designed to do.
“Our natural antibodies will fight the infection in most cases naturally by the bacterium being engulfed by special immune cells called granulocytes. But we are impatient and immediately go on to antibiotics,” Bonitas said in a statement.
The fund emphasised that taking antibiotics when you have a virus will not help and in some cases it will do more harm than good.
“Antibiotics only work on a bacterial infection,” Bonitas said, adding: “If you take them when they are not needed, your risk of developing an infection that is antibiotic resistant is increased.”
The medical fund also urged patients to complete their course of antibiotics even when they start feeling better. “Non-compliance with antibiotics is a major contributor to the development of superbugs.”
As a member state of the WHO, South Africa has a antibiotic resistance strategy in place that was published in May 2014 that aims to limit the need to use antibiotics and if needed to do so when appropriate.