Antibiotics - The
As we entered the
new millennium full of hope and optimism for the future, we saw the
warning signs but chose to ignore them. The dawn of the new millennium
was to be the beginning of a new and much improved era. But scientists
were already sounding alarm bells that our misuse of antibiotics in
the 20th Century would result in problems for the future. We ignored
those signals and today we are paying the price.
As this years bout of influenza reaches epidemic proportions,
the Government has issued an official quarantine announcement.
No person shall after 12 hours after the publication of this notice
be permitted to enter into or leave their respective counties on any
rail network, by road or in any manner whatsoever by any conveyance,
on foot or otherwise without first obtaining a permit from their local
The government authorities have today closed all schools and forbidden
all public meetings and gatherings, including funerals, in an attempt
to isolate the epidemic. Spanish flu, also known as the Spanish
Lady is believed to have reached our shores via the increased
number of holidaymakers that have visited Spain over the recent winter
months. The Costa resorts in Spain have been making a comeback as the
most popular European holiday destinations. They are cheap, cheerful
and only a two hour flight away. But it seems that as a nation, we are
now paying the price for peoples winter sojourns.
The repercussions of this disease are not just stopping at killing our
loved ones. The ramifications stretch much further. Today, the Government
has issued a statement that the Euro is at its all time lowest value
since it was introduced. Productivity has reached a virtual standstill,
the workforce is on sick leave in record numbers and has today reached
the 30 million mark.
In a short time the influenza virus has made its way here and is killing
people throughout Europe. More than 1.3 million people in Britain alone
have died in the last two months and a further 20 million people are
currently seriously ill, desperately fighting to stave off this killer
Medical experts are ordering people to go straight to bed and stay quiet,
eat plenty of nourishing food and try and maintain your strength to
fight off the illness. There is no cure for influenza. The disease must
run its course. Evidence seems to prove that this is a disease which
is principally spread by human contact, for example by coughing, sneezing
and spitting. It is therefore important that if you have any symptoms
resembling the common cold, you should remain in your home until they
Influenza weakens bodily resistance and there are grave warnings from
the medical world that there is an increased danger of bronchitis and
pneumonia developing. But we are today learning that there are an increasing
number of reported cases of pulmonary tuberculosis which is attacking
people whose immune system has been weakened by influenza. The country
now offers the perfect condition to encourage the spread of tuberculosis,
and this is where an even bigger danger lies.
As early as 1945 Sir Alexander Fleming who brought us penicillin, predicted
that the more antibiotics people take or feed their animals, the faster
bacteria will become resistant. But we didnt heed this warning.
Throughout the 1980's and 90's, rich people, and particularly women,
throughout the world visited the doctor with minor ailments and were
given antibiotics like children are handed out smarties. The more that
people paid for medical care, the more antibiotics they were given.
If the doctor had given them nothing, they would have simply gone elsewhere
to a doctor who would.
But when one person takes an antibiotic, it is not just an act of an
individual seeking a cure from infection, instead it is a social act
that stimulates resistance to the whole world of bacteria which implicates
us all. It affects everybody and not just the individual who took the
pill. Of course we need the drugs, surgery would be impossible without
them and people would have died anyway. But the drug has its limitations,
as we are now learning at our cost.
Antibiotics were never intended to be given for viruses; they were always
known not to be effective against them. Antibiotics were intended to
be used to fight infection. In the United States of America in the year
2000, one third of all antibiotics were mis-prescribed. They were administered
for viral infections against which they were powerless. Today we are
paying the price of the recklessness of our predecessors.
In Britain it was always a slightly different story. As a nation we
only accounted for 4% of the worlds antibiotic consumption. This
was due to the fact that we had at that time a National Health Service,
controlled by Government spending, and whilst there was medical treatment
offered free to everyone, there were certainly far fewer antibiotics
handed out than in the private medical sector, where people effectively
paid for that luxury. Britain was a stark contrast to other
countries. For example in the USA, Japan and Spain, antibiotics were
sold over the counter in pharmacies without the necessity of prescriptions
signed by doctors and the rich took them like common aspirin.
So today why do we have no effective antibiotics that are able to fight
the bacteria that surround us? There are many reasons. The most fundamental
is that ever since scientists invented antibiotics, the bugs they were
designed to combat have been one step ahead of the game. Their introduction
has lulled two generations into a false sense of security, people believing
that there will always be pills to fight any infection we get. However,
unless humans develop a solid immunity to bacteria, our ability to treat
infections will always be doomed to failure, just as it is right now.
We are now living in an era where the bugs are winning, and people are
dying because of it.
Dr Stuart Levy of the Alliance for the Prudent Use of Antibiotics, Boston
gave his first warning in 1981. He told us that the misuse of the drugs
will, without a shadow of doubt, cause problems for infections in the
future. He campaigned to a medical establishment that was not listening.
No one would accept that there would ever be a problem.
One particular bug staphylococcus aureus (SA) has always been scientists
primary target in the battle against antibiotic resistance. It is probably
the worlds most infectious agent. At any one time, one third of
us carry SA, usually in our noses, but most of the time it has no effect
on our health. However, SA was the main reason that until 1945 modern
surgery was almost impossible. Almost any operation would push SA deep
into the human tissue and lead to a potentially fatal infection. Penicillin
made surgery less risky because it killed SA and with that came the
saving of lives.
Within eighteen months of penicillins first use, the bacteria
SA had developed a system for chopping up the penicillin molecule. By
the late 1950's, 90% of all SA strains were already resistant to penicillin.
In 1959, the new antibiotic methicillin was introduced which
also effectively killed SA, but the same thing happened again. Within
eighteen months, SA was resistant to it. The proteins in the outer coat
of SA had changed to such an extent that the antibiotic couldnt
bind to it. This we know as MRSA (methiciliin resistant SA).
Its interesting that MRSA wouldnt exist as a bacteria we
cannot control if it werent for the antibiotic SA being invented
in the first place. The possibility of contracting MRSA has, since the
turn of the century, been overwhelming. Hospitals provide a near-perfect
environment for the bug to live and breed; they are full of patients
with wounds whose immune systems are suppressed.
This resistance compromises our ability to conduct modern medicine.
St Thomass Hospital, one of the most keenly aware hospitals and
the one with perhaps the best infection control systems in the country
has 80 cases of MRSA cases a month, double the figure of 10 years ago.
It is still unclear how many people MRSA kills. Death certificates give
the cause as cancer or heart attack and never MRSA because it is difficult
to isolate this as being the sole reason for death.
Most MRSA strains could be treated with some form of antibiotics and
in the year 2000, the most powerful antibiotic called vancomycin
had been discovered. Scientists believed that it could be used to conquer
any infection. It was almost always effective but like its predecessors,
bacteria began to evolve that could eat vancomycin. By the
year 2003 cases of VRSA (vancomycin resistant SA) were appearing across
the world. Scientists had been defeated yet again by what had been heralded
as the drug to fight all bugs.
Scientists believed that vancomycin had won the battle but
even they should have realised that whilst man has been on this planet
for thousands of years, bugs have been here for millions, vying for
their survival the whole time, and more importantly always winning.
The dilemma has always been how to get one step ahead of the bacteria.
By the last millennium, the pneumonia bug was acquiring multiple resistance.
Food poisoning bacteria such as E-coli and salmonella had also acquired
multiple resistance. But we were lucky, the number of fatalities was
never as high as it could have been. The Government took an early initiative
and stepped in to ban home cleaning agents that had been designed to
combat kitchen bacteria. Chemical anti-bacterial cleaners were found
to be extremely harmful. They killed the bacteria that were necessary
to prevent food poisoning. Our habits were forced to change and we all
reverted to the rather primitive method of using good old hot soapy
water. The cleaners were believed to play a large part in increasing
resistance to antibiotics.
As a result of that ban, Unilever was faced with huge class actions,
namely groups of people who joined forces to bring one of the most costly
lawsuits of our generation. David took on Goliath and won. Families
had lost loved ones to the deadly food poisoning infections and the
lawsuit was their only means to fight back. Unilever had been producing
anti-bacterial agents for years and we had unknowingly changed our cleaning
habits because of this wonder cleaner, believing it to be the most hygienic
way to clean the kitchen worktops. Unilever, as a result of the costly
lawsuit was forced into bankruptcy.
Potentially the most lethal of all, is the strain of multiple resistant
Tuberculosis which emerged at the turn of the century. At first it mainly
attacked in the United States, mostly drug addicts and sufferers of
AIDS and to a lesser extent people in less well-developed countries.
Because it largely affected this relatively small group of people, nobody
took any real notice. Today of course, we know that it is sweeping through
our populations afflicting those that are still weak after the current
As we look back to the year 2000 with our 20-20 hindsight vision, we
should have been better able to anticipate the potential of the spread
of tuberculosis. But we probably thought that we fixed tuberculosis
in the 1950's and were confident that it wouldnt return. However,
we only have to look at history to see that it has a nasty habit of
repeating itself. Look back at the Spanish influenza epidemic of 1918
and 1919 and it bears a striking resemblance to what we are experiencing
now, a little under a hundred years later.
The flu epidemic of 1918 killed millions of people as the illness swept
across the world. The American troops, who came home after the First
World War, were believed to have come into contact with the bug when
they were shipped overseas to Europe to help with the war. When they
began to return home, the epidemic hit the East coast ports like wildfire.
In a short time the flu made its way to 46 states killing more than
500,000 people in its wake. At the same time, ports in South Africa,
Cape Town and Durban, were also decimated.
It takes five to ten years to develop an antibiotic from the first stages
through to production and to the ultimate sale of the final product.
Unfortunately in the 1990's drug companies failed to see the development
of antibiotics as a lucrative enough field of research. They lost interest
and switched to more profitable areas. This ultimately led to a lull
and indeed a gap between old antibiotics that were SA resistant and
new ones that could possibly combat the bacteria.
In 2003 Linezolid was heralded as the drug to save the world
and was even successful against MRSA. It was seen as the drug to supersede
vancomycin - the ultimate antibiotic to continue where its
predecessor had ceased to be effective. But by 2006, it was already
struggling in its effectiveness and the battle was still being fought
to find a drug that was MRSA resistant.
Supercomputers began producing millions of possible compounds. The experiments
were changing to a more genetic means of testing which enabled scientists
to target bacteria more precisely. In 2006, with the aid of computer
technology, we believed that we were for the first time in history half
a step ahead of the game in the battle against MRSA resistant bacteria.
How wrong could we have been? The next wave of resistance was due to
come in the year 2020 or possibly 2025 which would have been completely
predictable, but it is here now in 2010. The problem is: we have no
new drugs ready and tested to fight the deadly bacteria.
The size of cities, the increase in Britains population and the
longevity of peoples lives have all added to the necessity of
our health service infrastructure changing, and changed it has. Gone
are the days when we had free health service for all. Admittedly there
were always queues and waiting lists for operations and consultations
with the medics but the most important thing was that it was free at
the point of service for all who needed it. There has nearly always
been an alternative private health service for those that could afford
it or for those who simply wanted to pay for a better service and a
private room with baskets of fruit.
Today of course, it is a completely different story. The National Health
Service, already beginning to lose favour at the turn of the century,
no longer exists at all. Today, we have only one, the Government private
health service. Today everybody needs to have some sort of private health
cover to pay for their medical bills. People used to think that we would
never end up with a health service that mirrored Americas, but
here we are with exactly that. Most of us grew up with a national health
service, and people assumed that the Government would always need to
find the funding for the service, no matter what. Votes, would be lost
if a Government lost the national health service altogether. But we
Of course, if people are so desperately poor that they cant afford
health cover then there is emergency cover available, but it is a standard
that is indifferent and in a separate part of the hospital. People are
left waiting for great lengths of time or sometimes they simply die
waiting. Doctors attend their private patients first. It is a sad cry
from the days of our once beloved National Health Service.
Variations of the Linezolid drug have constantly been updated,
but to no avail. Nothing seems adequate to combat tuberculosis. Back
in the year 2000, St Thomass hospital began screening patients
for resistant infections before allowing them into the hospital. Ten
years ago, it seemed overly sensitive and viewed as something that would
never be the normal way of accepting admissions. Today of course it
is the norm. Everybody is screened before they are admitted.
In every hospital in the country there are isolation wards. We have
been forced to go back to a drug-free era, back to a life before penicillin
was ever invented. Before penicillin, hygiene was of paramount importance
but once it was discovered it led to a complacency that was always inevitably
going to lead to problems.
In the days of Florence Nightingale, hospitals were spotlessly clean
with doctors and nurses acutely aware of the perils of infection. As
penicillin became more widely used, doctors failed to even wash their
hands as they went from patient to patient doing their daily rounds.
Germs were so easily transferred between bedding. Nurses were more aware
of the spread of germs, always diligently washing their hands between
patients but doctors on the other hand seemed to rely and act in a manner
that suggested that if any disease spread it would be okay; antibiotics
would look after the problem. It is attitudes such as these that led
to a heavy reliance on the drugs in the first place.
Today, the Government have issued the warning that nobody is to leave
their respective county without a permit for fear of spreading the influenza
bug. But the reality is a little different. The spread of Tuberculosis
is proving to be the bigger threat to us.
We no longer have a penicillin drug that is tuberculosis multiple resistant.
We had the drug and abused it and now we find ourselves living in a
time that few people thought would ever come. The gap in the research,
when no new drugs were being discovered, has hit us harder than we might
have imagined. If it hadnt been for this latest flu epidemic,
perhaps a new drug might have been found in time.
Without the effectiveness of penicillin to fight tuberculosis, what
are we left with? We have the rather archaic method of cutting out the
damaged lung caused by the disease, followed by the waiting - will they
die or wont they? We have reverted to the wait and see method.
Today, all we can do is isolate our victims to prevent the unnecessary
spread of the disease. But with the isolation, comes the division of
the family unit, children forced into the care of social services to
pray for sick relatives, hoping they will recover from the killer disease.
Before we had penicillin all we could do was wait and pray, and today
as I watch people die, all I can do is observe the irony of how we have
come full circle.
© YVETTE BARNETT