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!