What will we do when the drugs don’t work anymore? Antibiotic resistant bugs in the EU cause an estimated 25,000 deaths each year, plus an additional €1.5 billion in healthcare costs and productivity losses. And the problem is getting worse; the World Health Organization warns that the world is heading towards a post-antibiotics future because of the widespread overuse of antimicrobial drugs.

The discovery of antibiotics in the 20th century revolutionised modern medicine, yet misuse has led to the development of new strains of bacteria that are resistant to treatment. Without antibiotics, common infections could once again prove deadly, and routine surgeries (such as having your appendix removed or having a c-section) could be life-threatening.

Our partner think tank, Friends of Europe, will be hosting two events in November 2018 on the sustainability of European healthcare (‘Smart (dis)investment choices in healthcare‘ and ‘sustainability of healthcare‘). Also in November (12-18) is World Antibiotics Awareness Week and European Antibiotics Awareness Day. Ahead of these, we have decided to launch a debate on antibiotics.

What do our readers think? We had a comment from Sam, who argues that so-called “super bacteria” (microbes that are either extremely or totally resistant to drugs) are on the rise because of our over-use of antibiotics. Is he right? And, if so, what’s plan B? Could an increased focus on hospital hygiene and infection control be a partial solution? What new technologies are out there to replace antibiotics?

To get a response, we spoke to Christian Franken, Chief Pharmaceutical Officer of DocMorris, a Dutch online drug retailer. Are

The risk of antibiotic resistance and the creation of super bacteria (multidrug resistant bacteria, which are immune to several different antibiotics) is great. Use of antibiotics is definitely too frequent and partly incorrect. The introduction of new antibiotics will not win the war on antibiotic resistance alone. We should therefore strive to keep the use of antibiotics as low as possible in all areas.

There are numerous measures in place in the European Union to reduce the use of antibiotics. These must be pursued and developed further. For instance: use of antibiotics in livestock farming only for the treatment of infectious diseases and kept at a necessary minimum; setting of national goals on the use of antibiotics; use of alternatives such as inoculations, probiotics, prebiotics, bacteriophages and organic acids; introduction of agricultural practices, by which the importation and spread of disease in farm holdings is reduced; alternative husbandry systems, which can cope with reduced use of antibiotics; raised awareness regarding the topic of antibiotic resistance on all social levels but particularly for vets and farmers.

So-called ‘reserve antibiotics’ may be used for serious infections. These are usually only used in hospitals to combat serious infections, which – due to having developed resistance – no longer respond to the recommended antibiotics.

To get another perspective, we put Sam’s comment to Thomas Van Boeckel, a Postdoctoral Fellow at the Swiss Federal Institute for Technology (ETH) in Zürich whose research focus includes antimicrobial resistance. What would he say?

Well, I think we shouldn’t think of one single ‘plan B’. Concretely, there’s not really a plan B to treat infections, if we lose antimicrobials then we lose them. But there are many plan Bs to prevent infection. This indeed includes improving hygiene measures – things like improving water sanitation, building public toilets in countries that have a high burden of infectious disease, and also improving hygiene on farms.

Now, I think that in other countries that don’t have such a big problem of hygiene that the cheapest way to potentially limit the amount of antimicrobials that we currently use is to improve vaccine coverage. And there I think we really should think of investment in potentially expensive vaccines, because prevention [through vaccination] would still be much cheaper than relying on the antibiotic treadmill and continuing to try and discover more and more expensive antimicrobials, which is not sustainable from a public health perspective nor from a financial perspective.

Finally, we put Sam’s comment to Wolfgang Philipp, the Head of Unit for  Crisis management and preparedness in health at the European Commission’s Directorate-General for Health and Food Safety (DG SANTE). How would he respond?

The number of infections caused by so-called ‘super bugs,’ which are resistant to many antibiotics are increasing. So far there are relatively few infections caused by bacteria which are resistant to all known antibiotics, but extremely resistant bacterial infections are occurring more frequently. For example, there was recently a person who died from gonorrhoea which was extremely resistant. Another example is extensively drug-resistant tuberculosis, which we also call XDR TB. That is a major problem in many parts of Europe and there are also several countries struggling with rising levels of multi-resistant Enterobacteriaceae, which are bacteria that you find in the gut. Many countries are struggling with that kind of infection. Resistant infections cause more than 25,000 deaths per year in the EU and have huge economic implications.

To avoid the situation, or counteract the situation, there is the EU’s One Health Action Plan against Antimicrobial Resistance. That brings me back to the question asking about new technologies. That is a central part of this plan. The EU is, for example, investing large sums on research, on new antibiotics, as well as on new alternatives to antibiotics such as phage therapies, non-pharmacological infection prevention, and vaccines, as well as better diagnostics. Research on new treatments – although it is certainly absolutely essential – is only part of the answer. You also need to reduce unnecessary antibiotic use in humans and animals in order to reduce the occurrence of ‘super bugs,’ or at least reduce the risk of producing such super bugs. At the same time, we need to strengthen infection prevention and control to reduce the risk of infection.

Should we significantly reduce the use of antibiotics? And what is our ‘Plan B’ if we lose effective antimicrobial drugs? Let us know your thoughts and comments in the form below and we’ll take them to policymakers and experts for their reactions!

IMAGE CREDITS: (c) BigStock – Tyrannosaurus; PORTRAIT CREDITS: Christian Franken (c) DocMorris N.V.

17 comments Post a commentcomment

What do YOU think?

  1. avatar

    Yes, antibiotics should be only used as last resort and even in that case the decision should be an informed one and not lets try and hope for the best.

    For example, I noticed how easily many general practitioners prescribe antibiotics based on a mere observation, without a lab test to confirm, say a bacterial vs a viral infection, too many are too often being given antibiotics for colds and other viral infections. I guess, the easiness by which many doctors prescribe antibiotics, might be dictated by the risk of malpractice to which they might be expose if that it’s an actual bacterial infection.

    In my opinion there are a few things that can be done to reduce and improve the use of antibiotics.

    First, we need better methods to detect bacteria/type. Current methods of bacterial culture test takes anywhere between 2 to 5 days or longer. New AI pattern detection and micro technologies might be able help with this.

    Second, provided that a specific type of bacteria was identified, develop better antibiotics to target these specific types of bacteria rather than bleaching whole microbiome.

    At last, we should invest more in research that studies the microbiome, as such as in the human gut which is under way. We need a better understanding of the dynamics and function of all the many types of bacteria and their symbiotic relationship with us and the environment. This will provide researchers with a better understanding and help devise new strategies.

  2. avatar

    … yes … including in agriculture! In addition the pharmaceutical industry should swallow their greed and act altruistically by investing in development of new antimicrobials

  3. avatar

    Yes we should. They were only ever for a once in a lifetime illness . Theyre given out far too often by doctors.

  4. avatar
    catherine benning

    Should we significantly reduce our use of antibiotics?

    How can an overall question in this matter be taken seriously?

    Antibiotics are a life saving product. To blithely ask if we should stopor reduce their use is ludicrous. It isn’t that simple is it?

    What has gone wrong here is, misuse, and over prescription. Places where these medications are sold in the world, without proper prescription, dosage, etc, is the reason they are not doing their job the way they used to. Which is the cause of society as a whole having to discuss their possible withdrawal.

    To have a blanket prohibition or reduction on their use, however, would leave millions of people in dire straits as they do still cure serious infection in many. We need science to find another form of medicine that will once again work the way penicillin did originally. Before it was abused, willy nilly, by us all.

  5. avatar

    Yes absolutely, and whilst we are at it, we should ensure that any trade deals do not allow imported meat that has been subject to antibiotics as growth promoters or from intensive systems that use antibiotics prophylactically on a regular basis.
    Animals that have needed them on an individual basis should not be slaughtered until the antibiotics have completely cleared their system.

  6. avatar

    Actually giving antibiotics for a viral infection isn’t the problem people make it out to be, it’s just a waste, nothing more. Patients not finishing the prescribed course is what has caused this problem. There’s a much bigger problem; agriculture and it’s wanton use of all drugs. AND get this, antibiotic residue leaves the patients body in their urine. During WW2 doctors would harvest antibiotics from soldier A’s urine and give it to soldier B. For the last 60 years this antibiotic residue has been flushed into our rivers and lakes. Frightening to think what organisms have grown completely oblivious to any and all antibiotics due to this.

    • avatar

      It sort of is: repeated exposure to antibiotics (like given for viral infections), means that opportune pathogens that are part of normal gut flora, are predisposed to antibiotic resistance, through repeated exposure. This results in a normal gut flora, that’s an opportune pathogen, are effectively weeded out so the antibiotic resistant strain become the dominant organism (as happens with, for example, E. coli). That’s without considering the resistance of bad bacteria, like C. difficile

  7. avatar

    I have been prescribed antibiotics and anti-inflammatories that I didn’t really need by the dozens and then on the other hand I have been in situations when I have not been prescribed antibiotics when I needed them. So, I think that the real issue here is the quality of healthcare that we get. In my opinion, unless confirmed by a bool test that antibiotics are needed, they should not be prescribed but also if the blood test shows that people do need an antibiotic they should not be refused.

    • avatar

      heheheeheheheheehheheehehehehehehehehehehewheheheeheh A growing number of infections – such as pneumonia, tuberculosis, gonorrhoea, and salmonellosis – are becoming harder to treat as the antibiotics used to treat them become less effective. Antibiotic resistance leads to longer hospital stays, higher medical costs and increased mortality.Feb 5, 2018

  8. avatar

    We need to reduce unnecessary antibiotic use in humans and animals in order to reduce the occurrence of super bugs, or at least reduce the risk of producing such super bugs. At the same time, we need to strengthen infection prevention and control to reduce the risk of infection.
    Why is it important to limit the use of antibiotics?
    Because doctors should not prescribe antibiotics for most colds, coughs and sore throats because they don’t help and their overuse is making them less effective against other infections. #getridofsuperbugs

  9. avatar
    Sasha + Devon :D

    Yes. Definitely. Antibiotics are vital for the health and wellbeing of both animals and man. The development of resistance to antibiotics is a major concern, and for that reason their use is under increased scrutiny. As is the case in the US and Mexico, the quantity of antibiotics used to raise pigs in Canada is significantly greater than in Denmark, where efforts to reduce their usage have been made for many years.

    Since the discovery of penicillin by Sir Alexander Fleming in the 1920s, antibiotics have played an enormous role in Man’s quest for a better and longer life. Today, these products are still extremely important for the well-being of both humans and animals, and for that reason everything that can alter their efficacy is closely scrutinised. Antibiotics are used in swine production with various objectives in mind.

    The main concern behind these discussions is that if antibiotics are used a lot in animals, veterinary pathogens or commensals may become more resistant to antimicrobials, and if so, could transfer that resistance to human pathogens. Furthermore, some organisms carried by pigs have the potential to create problems in humans, and these organisms may be directly transferred to people though manipulation or consumption of meat products. If these strains of organisms are resistant to antibiotics, the treatment of these conditions obviously becomes an issue.

  10. avatar

    More antibiotics were used for growth promotion than for therapeutic use in 1992. But then various measures were taken to phase out growth promotion use of antimicrobials and in 2000, antimicrobials were not used anymore for that purpose. This did create an increase in the therapeutic use of these products, but the end result is still that by 2008, Danish pig production was using less than 50 per cent of the total they were using in 1992.

    An international review panel, set up by WHO at the request of the Danish government, concluded that the ban reduced human health risks without significantly harming animal health or farmers’ incomes. In fact, Danish government and industry data showed that livestock and poultry production actually increased following the ban, while antibiotic resistance on farms and in meat declined.

    Nevertheless, as the antimicrobial consumption was steadily increasing after 2000, they decided in 2010 to put in place some additional measures to stop and hopefully reverse that trend. Since then, if a producer uses two times or more the average quantity of antimicrobials used by Danish producers, he/she receives a yellow card. The producer then has nine months, working with his or her herd veterinarian, to correct the situation. If this does not work, another veterinarian gets involved in the farm, and if this still does not produce the desired results after five months, other measures are discussed but not currently implemented. One of the potential measures would be a decrease of animal inventory until antimicrobial consumption goals are met.

  11. avatar

    Antibiotics are important medicines, however it is also important that everyone understands that they only work against bacteria. Antibiotics do not work against infections caused by a virus and will not make you feel better.

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