Before the advent of antibiotics 70 years ago, an infected paper cut could mean a death sentence. Drugs revolutionized medicine; life-threatening infections could be prevented and treated within days. But now, more and more bacteria are learning how to avoid antibiotics. How do we face this growing problem?
By
Signe Dean / SBS Radio

18 Sep 2015 - 4:34 PM  UPDATED 28 Sep 2015 - 3:14 PM

Before the advent of antibiotics 70 years ago, an infected paper cut could mean a death sentence.

Drugs revolutionized medicine; life-threatening infections could be prevented and treated within days.

But now, more and more bacteria are learning how to avoid antibiotics.

How do we face this growing problem?

Signe Dean investigates.

The World Health Organisation describes antibiotic resistance  as a looming global health crisis.

For seven decades we've been using antibiotics to stave off life-threatening infections.

Westmead Hospital infectious diseases clinician and University of Sydney microbiology Professor Jon Iredell [eye-a-DELL] says thousands  of people present to emergency departments with severe infections every day.

"In fact, severe infection of this type kills more Australians every year than breast cancer or bowel cancer, and about three times as many as the roads. So I don't think people are aware of just how common death due to severe infection actually is."

To combat these infections, we use antibiotics.

The quicker they are administered, the higher chance of survival.

But increasingly bacteria are adapting to our weapons and rendering them useless.

"The problem is, of course, that if we use a lot of antibiotics then bacteria adapt, bacteria have been adapting to pressure from the world around them since long before mammals evolved on this planet, and it's only really been the last handful of decades that humans have developed specific antibacterial drugs and started to expose bacteria to them, and of course they have quickly adapted in the way they have forever adapted to other stress."

Sydney University of Technology's ithree institute focuses on understanding and controlling infectious diseases in humans and animals.

Director of ithree and Biology Professor Liz Harry explains that antibiotic resistance has been impossible to avoid, thanks to our lack of knowledge of genetics and evolution.

"There are a number of rescue systems that the bacteria have, they've had them for billions of years. The ability of bacteria to become antibiotic resistant is encoded in their genes."

What's more, bacteria can share their genes both within and between species.

Bacteria live absolutely everywhere, the vast majority are both useful and necessary for our health.

Only bad bacteria cause trouble, sometimes impacting our health seriously.

Some bacteria have even managed to turn into superbugs.

Professor Harry explains.

"A superbug is usually defined as such because it is resistant to a number of different antibiotics. And so it's important to identify those because it means that very few, sometimes one, and now sometimes no antibiotics will work to treat infections by superbugs."

A famous example of a superbug is the resistant golden staph known as M-R-S-A.

But others have been emerging, including variations of E.coli, [E-kolai] a usually friendly bug we all carry in our guts.

When a person dies from a superbug infection, it's a throwback to the era when we didn't have any antibiotics and people often died from infections.

According to Professor Iredell our future could look like the past.

"The worst case scenario would be that bacterial infection would have no remedy essentially, or at least that a significant number of bacterial infections would have no remedy, so that we would be going back to where we were around the First World War, where, if you had an infection that's complicated some big procedure, like a surgical procedure, it would be literally a lethal event."
    
Professor Harry says that in a way we have already reached this stage.

"So we're going back to the pre-antibiotic era. I think that we're already there in some ways. We definitely have some drugs that are effective against lots of different infections, but there is an increasing number of infections that we have very few drugs. We already have tuberculosis that is completely resistant to any drugs that we have, there's not much of that in Australia, but it's happening in other parts of the world where there is a lot of T-B, and there's no reason to believe that this could not happen with a lot of other bacteria to which we take antibiotics.

A recent review on antimicrobial resistance from the UK government estimates that resistant infections are already killing 700 thousand people every year.

And we rely on antibiotics to perform other life-saving treatments including major surgeries such as organ transplants and joint replacements.

Without antibiotics to protect us from infection, we can expect more deaths from surgery complications.

How did we get here?

According to OECD data, Australia has one of the highest antibiotic consumption rates among developed countries.

Professor Iredell says overuse of antibiotics needs to be tackled.

"Obviously if antibiotics are causing bugs to become resistant, then if you use antibiotics only when you need to, then you will be less likely to drive resistance development. So one of the things we have got to all learn in hospitals is that we need to use antibiotics only when they're necessary. They've been seen for a long time as something that's really beneficial, and I guess it's natural for humans to think if a little bit is good, then more must be better. But I think more is not better for antibiotics, and that's a key message.

Studies have shown that general practitioners tend to prescribe antibiotics for things like the common cold.

This is unnecessary, because antibiotics can't kill viruses.

And when people don't use antibiotics as prescribed, this can increase the risk of resistance.

University of Adelaide microbiologist Associate Professor Darren Trott explains that this applies not only to humans.

"Many of my medical colleagues regard pets as little people in furry suits. We should be thinking often of our pets the same way as we do with our children, and use antibiotics the same way as they're used in humans. For example, your doctor will tell you, 'this is your course of antibiotics, it must be used as I said, take the drug twice a day for seven days, don't skip any tablets,' and people have to treat their pets in the same way."

Another major contributor to the rise of superbugs is antibiotic overuse in agriculture and farming.

Professor Trott says Australia has regulation in place.
 
"We're very fortunate in Australia in that much of the meat that we raise is raised under what we call extensive grazing conditions, and many of those animals will never see an antibiotic in their life, or it might be a one-off treatment in an individual animal. I think we can always do things better, certainly the trend now is to try to raise animals with as little antibiotics as possible, try to use them only when absolutely necessary, and try to look at improving management practices and other methods of controlling disease such as vaccines."

But hospitals are a breeding ground for superbugs.

There are things we can do to prevent not taking the bacteria home.

Professor Trott explains the importance of good hygiene.

"The most important thing we can do to prevent antibiotic resistance is good hygiene - washing our hands well, and particularly when you're visiting people in hospital, use those hand sanitisers before and after."

But you shouldn't try to kill all bacteria.

UTS' Professor Harry points out why using antibacterial soap at home is a bad idea.

"When you wash your hands, you can use a soap or a liquid soap, but we don't need an antibacterial soap, because again, the bacteria in our house, after using antibacterial soap, they're just gonna be resistant to it.  Most bacteria are really good for you, and what we have to do is be careful at how we treat the bad ones."

In June, the federal government announced a new strategy aimed at reducing the threat of antibiotic resistance.

It's built upon the One Health principle - recognising human, animal and ecosystem health as an intricately  linked issue.

Professor Trott explains this connection.

"We're all part of this microscosm, and that means an antibiotic administered in one particular area may have some effect - you know, that butterfly effect somewhere else in the environment."

It has seven objectives, including raising awareness, national coordination, as well as a national research agenda for creating new antibiotics.

Looking for new drugs is a major part of the future of antibiotics.

Microbiologist Professor Trott is optimistic.

"We're finally getting onto all the same page - governments are putting investment into new drugs, that's what we really need, we need new classes of drug, and what you'll find those new classes of drug will only be reserved for human medicine, we'll never see them used in animals."

Professor Liz Harry says its essential industry and academia continue developing new antibiotics.

"The resistance problem is actually driving down the incentive for producing new antibiotics. What we can do about this is we can fund the development of new antibiotics - either through companies or, hopefully both through academic researchers and companies, and help them work together more, so that we can actually develop these drugs. Because we will need them, and I'm really concerned that we won't have them by the time we really start to have significant numbers of deaths from this."

Professor Jon Iredell says there are several approaches to creating new antibiotics.

"We need to find new ways to kill bacteria. And so there are a lot of people who are working on finding new drug targets as they call them, in other words, finding ways that the bacteria haven't yet adapted to. That's the traditional approach, which is the new drug approach."

Researchers are also trying to make bacteria ineffective.

"Strategies that are designed to make the bacteria do less harm without killing them are not likely to cause the bacteria to change a great deal, but may solve the problem of the infection. So this is a really important strategy, and there's a lot of interest in targetting processes in the bacteria that cause a lot of harm, as opposed to processes in the bacteria that the bacteria need to survive."

Without the threat of being killed, a bacterial population is less likely to evolve into resistance.

And what about alternatives?

Professor Liz Harry from UTS is also investigating the potential of honey as a topical treatment.

"We know very little about what happens when you ingest honey in terms of the treatment, infection treatment. So I would suggest that at the moment honey is mainly used on a wound, or a cut on your skin. So, when I say topical, I mean on the outside of the body."

It's important to note that eating honey is not going to have the same effect as drugs.

With continued research, it may be several years before we have any drugs that can kill a superbug.

Meanwhile resistant bugs are everywhere but we can limit their impact with more careful antibiotic use.

Ditch the antibacterial soap at home and ask your doctor -- do I really need antibiotics for that?