Antibiotics are used around the world to treat bacterial infections. Only a century ago, infections such as tuberculosis, syphilis and gangrene were killing people at phenomenal rates. Since Alexander Fleming’s accidental discovery of penicillin in 1928, effective antibiotics have been readily available. So why are we suffering from side effects of antibiotics now?

There are times when I prescribe an antibiotic and a week later the patient returns no better than when they started. Another drug and another week passes and they are still unwell. There are other times when I sit down with patients and they demand an antibiotic. It won’t do any good, I say. You have a viral infection, you need time and rest. But it’s no good, there is an attitude that if your doctor won’t give you an antibiotic, they aren’t doing anything. What is happening?

An antibiotic is a substance derived from a microorganism (or produced synthetically) which kills or controls the growth of bacteria. They work by one of two primary mechanisms: they kill the bacterium or they inhibit their growth and reproduction. However, there have been strains of bacteria which have been insusceptible to antibiotic treatment. Over time, resistant strains have become more and more prevalent, making infections far harder to treat and threatening the efficacy of antibiotics. So, instead of working positively for our health we see the side effects of antibiotics.

Resistance occurs when bacteria mutate in order to defend against antibiotics. Members of the surviving strains then reproduce to further propagate the number of resistant bacteria. The development of super bugs, which are impervious to several types of antibiotics, is also a massive problem. These infections include MRSA, CRE and Clostridium Difficile and kill tens of thousands of people each year. It is estimated that the global cost of antibiotic resistance will come to $100 trillion by 2050.

One of the primary causes of this problem is the irresponsible over-prescription of antibiotics in healthcare. For example, antibiotics are useless against viral infections but it will allow bacteria to come into contact with the antibiotic and heighten the chance of it mutating into a resistant strain. Secondly, the addition of antibiotics into the environment through farming has also given bacteria further opportunities to develop resistance. Finally, the development of new antibiotics has come to halt in recent decades.

We are now in a situation where the use of ‘reserve’ antibiotics is becoming more and more common, in spite of their adverse side effects and higher levels of toxicity, because there are simply no other options.

So how do we avoid reaching the point where infection reclaims its position as a lethal killer? One important step is a change in attitudes towards antibiotics. Guidelines for responsible stewardship have become increasingly common in the last few years and doctors and nurses need to start taking them seriously. It is also our duty to take the time to explain the situation to their patients if they feel antibiotics are inappropriate. Global efforts must be made to further the development of new antibiotics and reduce the overall demand for antibiotics through infection control measures, vaccination and widespread access to clean food and water. Finally, if we want to ensure the efficacy of antibiotics and not to face the side effects of antibiotics, we must begin to treat them as the unique and finite resource that they are.

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