Constable

• This month, The Conversation’s experts explore how we got here and the potential solutions.
• These days, we don’t think much about being able to access a course of antibiotics to head off an infection.
• But that wasn’t always the case – antibiotics have been available for less than a century.

Life (and death) before antibiotics

• But the first patient to receive penicillin was an instructive example of the impact of treatment.
• In 1941, Constable Albert Alexander had a scratch on his face that had become infected.

• Therefore, he felt it was only ethical to give this new drug to a patient in a desperate condition.
• We now face a world where we are potentially running out of antibiotics – not because of difficulties manufacturing them, but because they’re losing their effectiveness.
• Read more:
  Will we still have antibiotics in 50 years?

What do we use antibiotics for?

• Antibiotics reduce the duration of illness and the chance of death from infection.
• They also prevent infections in people who are at high risk, such as patients undergoing surgery and those with weakened immune systems.
• Studies consistently show a dose or two will adequately prevent infections after surgery, but antibiotics are often continued for several days unnecessarily.

• If the patient is improving, doctors tend to simply continue the same treatment, rather than change to more appropriate choice.
• This is particularly the case for tuberculosis, caused by a slow growing bacterium that requires a particularly long course of antibiotics to cure.
• Here's how it spreads and who is at risk

  As in humans, antibiotics are also used to prevent and treat infections in animals.

• In Australia, an estimated 60% of antibiotics were used in animals between 2005-2010, despite growth-promotion being phased out.

Why is overuse a problem?

• For example, antibiotics are sometimes given to prevent recurrent urinary tract infections, but a consequence, any infection that does develop tends to be with resistant bacteria.
• Read more:
  Rising antibiotic resistance in UTIs could cost Australia $1.6 billion a year by 2030.
• New drugs for some bacteria have been developed, but many are much more expensive than older ones.

Treating antibiotics as a valuable resource

• The concept of antibiotics as a valuable resource has led to the concept of “antimicrobial stewardship”, with programs to promote the responsible use of antibiotics.
• Therefore, like efforts to combat climate change, antibiotic stewardship relies on changing individual actions to benefit the broader community.

• Studies have linked resistance to the values and priorities of governments such as corruption and infrastructure, including the availability of electricity and public services.
• There are also issues with the economic model for developing new antibiotics.
• Read more:
  We need to change how antibiotics target bugs if we want them to keep working

The slow moving pandemic of resistance

• Almost all infectious diseases physicians have had the dreaded call about patients with infections that were essentially untreatable, or where they had to scramble to find supplies of long-forgotten last-line antibiotics.
• A global study estimated that in 2019, almost 5 million deaths occurred with an infection involving antibiotic-resistant bacteria.
• The UK’s 2014 O'Neill report predicted deaths from antimicrobial resistance could rise to 10 million deaths each year, and cost 2-3.5% of global GDP, by 2050 based on trends at that time.

What can we do about it?

There is a lot we can do to prevent antibiotic resistance. We can:
raise awareness that many infections will get better by themselves, and don’t necessarily need antibiotics
use the antibiotics we have more appropriately and for as short a time as possible, supported by co-ordinated clinical and public policy, and national oversight
monitor for infections due to resistant bacterial to inform control policies
reduce the inappropriate use of antibiotics in animals, such as growth promotion
reduce cross-transmission of resistant organisms in hospitals and in the community
prevent infections by other means, such as clean water, sanitation, hygiene and vaccines
continue developing new antibiotics and alternatives to antibiotics and ensure the right incentives are in place to encourage a continuous pipeline of new drugs.
Read the other articles in The Conversation’s series on the dangers of antibiotic resistance here.
Allen Cheng receives funding from the Australian Government and the National Health and Medical Research Council. He is affiliated with the Centre to Impact Antimicrobial Resistance at Monash University.