'Alarm bells will turn into the death knell': Now is the time to act on antibiotic resistance, expert warns

·4-min read
Concept of pharmacy
Many bacterial infections have developed resistance to antibiotics. (Stock, Getty Images)

An expert has warned now is the time to act on antibiotic resistance – before "alarm bells turn into the death knell".

The World Health Organization (WHO) has called antibiotic resistance "one of the biggest threats to human health". Infections that are currently considered to be almost harmless may one day be incurable, with once-effective drugs becoming useless.

Antibiotics become less effective the more they are used. Inappropriate prescriptions and patients failing to take the drugs properly mean many bacterial infections have evolved resistance, bypassing the medication that is trying to destroy them.

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Speaking at the European Congress on Clinical Microbiology & Infectious Diseases, Professor Dame Sally Davies – England's former chief medical officer – asks how many more warnings are needed before it is too late.

In a WHO-sanctioned session, Dame Davies looks at the scant progress that has been made in recent years.

As resistance continues to grow, pharmaceutical companies may be less incentivised to develop new antibacterial drugs – which rid patients of an infection relatively quickly – over a once-a-day blood pressure or cholesterol treatment.

Read more: Cancer and diabetes drugs could treat antibiotic-resistant gonorrhoea

"Time and again, the alarm bells have sounded for the broken antibiotic market," said Dame Davies.

"Compared to $8bn [£5.8bn] of profit for cancer drugs, the $100m [£72.6m] loss for antimicrobials means our medicine cabinets are becoming emptier – because of bankruptcies, not lack of scientific brainpower."

"Antimicrobials" refers to treatments that work against any pathogen, including bacteria, viruses and fungi.

"As it stands, the weak market and lack of access leaves patients paying – and future generations will suffer even more," added Dame Davies, now the UK's special envoy on antimicrobial resistance.

Illustration of Neisseria gonorrhoeae bacteria. These are pairs of bacteria, called diplococci, with hair-like pili on their surfaces. Pili mediate movement, adherence and DNA (deoxyribonucleic acid) exchange. Neisseria gonorrhoeae causes the sexually transmitted genitourinary infection gonorrhoea.
Gonorrhoea has evolved into a 'superbug', resistant to nearly all antibiotics. (Stock, Getty Images)

In 2015, antibiotic use had increased by 6.5% over the past four years in England alone. In the US, at least 30% of the drugs prescribed are considered to be "unnecessary".

One of the most well-known examples is methicillin-resistant Staphylococcus aureus (MRSA).

The bacteria S. aureus live harmlessly on the skin of around one in 30 people. If they enter the body, however, S. aureus can trigger dangerous infections.

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Now resistant to the antibiotic methicillin, MRSA are said to kill more people in the US every year than acquired immune deficiency syndrome (Aids), Parkinson's disease, the lung condition emphysema and murder combined.

"I have been saying 'there is no time to wait', but for many it is already too late, they have died," said Dame Davies.

"Unless we act now, the alarm bells will soon turn into the death knell for modern medicine."

In June 2021, the G7 nations committed to strengthen research and development into new antibiotics.

In the US, The PASTEUR Act – pending a vote by the US government house of representatives and congress – aims to uncover new antibiotics for patients who need them the most.

Under this legislation, the US federal government would provide market incentives for pharmaceutical firms to develop life-saving antimicrobials.

Pharmaceutical companies would be paid contractually agreed amounts every year, for a period of between five years up to the drug's patent expiring.

The contracts would specifically promote the development of drugs that work against so-called "superbugs". These are considered to be the most threatening by the US Centers for Disease Control and Prevention, including the fungus Candida auris and the bacteria Clostridioides difficile.

The PASTEUR contracts would also act incentives to develop new classes of drugs with novel mechanisms, helping to ward off resistance.

Existing antibiotics target the bacteria's cell wall – killing the pathogen – or suppress its division, enabling the immune system to better fight off the infection naturally.

The UK has launched a world-first "Netflix-style" model, which pays pharmaceutical companies a fixed amount – via a subscription – for access to their antibiotics, as opposed to fees based on how much the drug is used.

With antibiotics becoming less effective the more they are taken, medics are told not to dole them out unnecessarily, further putting pharmaceutical companies off creating new drugs.

In December 2020, the UK government purchased two antimicrobials developed by the firms Shionogi and Pfizer via the Netflix-style model.

"Globally, we need to we move forward together, working in partnership across sectors and countries," added Dame Davies.

While scientists work to solve the problem, the public can help combat antibiotic resistance by following prescriptions carefully, never sharing or skipping doses.

Good hand hygiene and staying up-to-date on vaccines also helps.

Watch: Antibiotic resistance may lead to more coronavirus deaths